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presented  to  the 
UNIVERSITY  LIBRARY 
UNIVERSITY  OF  CALIFORNIA 
SAN  DIEGO 

by 


Mrs.  Griff ing  Bancroft 


Digitized  by  the  Internet  Archive 

in  2007  with  funding  from 

Microsoft  Corporation 


http://www.archive.org/details/feminaworkforeveOOmilliala 


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JOHN    A  .   M I L  L  E  R ,    M .   D 


FEMINA, 


A  WORK  FOR  EVERY  WOMAN 

ILLUSTRATED. 


A  perfect  woman,  nobly  plann'd, 
To  warn,  to  comfort  and  command; 
And  yet  a  spirit  still,  and  bright, 
With  something-  of  an  angel  light. 

—  Wordsworth. 


JOHN  A.  MILLER,  M.  D. 


Graduate  Medical  Department  University  of  California,  also  holding 

Credentials  from  the  Universities  of  Berlin  and 

Heidelberg,   Germany. 


SAN   FRANCISCO, 

THE   FEMINA   COMPANY, 

1893. 


Entered  According  to  Act  of  Congress,  in  the  Year  1893 
BY  JOHN  A.  MILLER, 
In  the  Office  of  the  Librarian  of  Congress, 
at  Washington,  D.  C. 


TO 

THE     LATE 

DR.    CARL   SCHROEDER, 

PROFESSOR    OP     DISEASES    OF     WOMEN 

IN    THE    FREDERICK    WILLIAM    UNIVERSITY,    BERLIN: 

MY    TEACHER    AND    FRIEND. 


f 


PREFATORY  NOTE. 


The  publication  of  this  volume  was  suggested  by  the  astonishing  ig- 
norance displayed  and  the  antiquated  ideas  entertained  upon  questions 
of  health  and  disease  by  most  persons  with  whom  I  came  in  professional 
contact,  even  by  those  who  were  accomplished  in  other  subjects  of  a 
scholastic  and  scientific  nature.  The  practical  importance  of  the  subject 
naturally  led  me  to  the  consideration  of  diseases  that  are  essentially  in- 
flammatory, for  over  seventy-five  per  cent  of  all  diseases  of  women  are  of 
an  inflammatory  nature.  In  this  respect  the  book  differs  from  other 
works  on  similar  subjects. 

In  discussing  this  class  of  diseases  I  have  aimed  to  present  a  treatise 
simple  in  style,  and  easily  understood  by  the  casual  reader.  While  I 
have  endeavored  to  impart  strictly  scientific  information,  I  have  tried  to 
impart  it  in  familiar  language,  avoiding  the  use  of  technical  terms  as  far 
as  possible,  and  carefully  defining  them  when  their  use  became  indis- 
pensable. 

JOHN  A.  MILLER,  M.  D. 

No.  1137  Geary  Street,  San  Francisco,  Cal. 


(^-<j$k>  •*& 


BY  THE  SAME  AUTHOR. 


MEDICAL  EDUCATION  IX  THE  UNITED  STATES  AND  AN  OUT- 
LINE OF  THE  GERMAN  SYSTEM.  Essay  read  before  the 
Alumni  Association  of  the  Medical  Department  of  the  University 
of  California,  March,  1886. 

EROSIONS  OF  THE  VAGINAL  PORTION  OF  THE  CERVIX,  OR 
ULCERATION  OF  THE  SAME  PART.  Pacific  Medical  and  Sur- 
gical Journal,  January,  1S87. 

RETROVERSIO-FLEXIO  AXD  A  NEW  INSTRUMENT  FOR  THE 
REPOSITION  OF  THE  UTERUS.  American  Journal  of  Obstetrics 
and  Diseases  of  Women  and  Children,  February,  1887. 

UTERIXE  HEMORRHAGE  AND  LIGATION  OF  THE  UTERINE 
VESSELS  AS  A  THERAPEUTIC  EXPEDIEXT.  The  New  York 
Medical  Record,  September,  1889. 

PHLEGMASIA  ALBA  DOLEXS,  OR  MILK  LEG;  ITS  PATHOLOGY 
AXD  TREATMEXT  BY  MEAXS  OF  COLD  WATER  COMPRESSES 
AND  ICE  BAGS.    Pacific  Medical  Journal,  June,  1891. 


<^t^' N 


d^$5 


CONTENTS. 


CHAPTER  I. 
THE  REASON  WHY 15 

CHAPTER  II. 

DELUSIONS  AS  TO  THE  CURATIVE  VALUE  OF  DRUGS 36 

CHAPTER  III. 

WHAT  IS  MIND  CURE? 46 


CHAPTER  IV. 

GENERAL  CAUSES  OF  UTERINE  AND  PELVIC  DISEASES  OF 
WOMEN 61 


CHAPTER  V. 

UNCLEANLINESS  AS  A  CAUSE  OF  DISEASES  IN  WOMEN 76 

CHAPTER  VI. 

MARITAL  EXCESSES  AND  PREVENTION  OF  CONCEPTION...  87 

CHAPTER  VII. 

CRIMINAL  ABORTION  OR  FETICIDE 101 


CONTENTS. 

CHAPTER  VIII. 

ANATOMY  OF  THE  FEMALE  ORGANS 119 

CHAPTER  IX. 

MENSTRUATION  AND  MENSTRUAL  DISORDERS 126 

CHAPTER  X. 

HISTOLOGY  OF  INFLAMMATION 145 

CHAPTER  XI. 

URETHRITIS  AND  NEURALGIA  OF  THE  URETHRA 150 

CHAPTER  XII. 

INFLAMMATION,    CATARRH,  AND    OTHER  DISORDERS    OF 
THE  BLADDER 157 

CHAPTER  XIII. 

ACUTE  AND  CHRONIC  INFLAMMATION  OF  THE  VAGLNA....172 

CHAPTER  XIV. 

HYGIENIC  MEASURES  FOR  CATARRHAL  DISEASES  OF  THE 
FEMALE  ORGANS.. 182 

CHAPTER  XV. 

METRITIS  OR  INFLAMMATION  OF  THE  WOMB 196 

CHAPTER  XVI. 

CHRONIC  METRITIS  OR  CHRONIC  INFLAMMATION  OF  THE 
WOMB 203 


CONTENTS. 

CHAPTER  XVII. 

ENDOMETRITIS  OR  CATARRHAL  INFLAMMATION  OF  THE 
WOMB 209 

CHAPTER  XVIII. 

THE  NATURAL  POSITION  OF  THE  UTERUS  AND  HOW  IT 
IS  SUPPORTED 226 

CHAPTER  XIX. 

PROLAPSUS  OR  FALLING  OF  THE  WOMB 231 

CHAPTER  XX. 

VERSIONS  AND  FLEXIONS  OF  THE  WOMB 240 

CHAPTER  XXL 

DISEASES  OF  THE  FALLOPIAN  TUBES 258 

CHAPTER  XXII. 

DISEASES  OF  THE  OVARIES 263 

CHAPTER  XXIII. 

PERIMETRITIS  AND  PELVIC  PERITONITIS 275 

CHAPTER  XXIV. 

PELVIC  CELLULITIS  OR  PARAMETRITIS 285 

CHAPTER  XXV. 

ELECTRICITY  AS  A  REMEDY 294 


CONTENTS. 

CHAPTER  XXVI. 

SIGNS  AND  SYMPTOMS  OF  PREGNANCY 305 

CHAPTER   XXVII. 

PRECAUTIONS    AND    SUGGESTIONS    TO    PREGNANT 

WOMEN 315 

CHAPTER   XXVIII. 
WHILE  IN  CHILD  BED 328 

CHAPTER   XXIX. 
DISEASES  PECULIAR  TO  CHILDREN 341 

CHAPTER  XXX. 

DISEASES  PECULIAR  TO  CHILDREN— Continued 356 

CHAPTER  XXXI. 

EMERGENCY  TREATMENT  IN  SUDDEN  ACCIDENTS 377 

CHAPTER  XXXII. 

SOMETHING  ABOUT  DIET 392 


CHAPTER  I. 

THE    REASON    WHY. 

I  see  a  large  field  of  usefulness  which  has  not  been  cov- 
ered by  competent  authorities.  I  propose,  therefore,  to  offer 
a  plain,  simple  statement  of  the  most  common  causes  of 
physical  suffering  in  women,  and  a  simple  and  reliable 
method  of  home  or  domestic  treatment,  to  be  carried  out 
by  the  patients  themselves,  which,  in  the  great  majority  of 
cases,  is  easily  applied. 

The  first  nine  years  of  my  professional  life  was  an  untir- 
ing and  incessant  devotion  to  the  arduous  demands  of  a 
large  family  practice,  after  which  I  decided  to  go  to  Europe, 
and  there  prosecute  such  studies  in  two  German  universities 
as  my  experience  as  a  practitioner  had  fully  convinced 
me  to  be  of  the  greatest  practical  and  scientific  importance; 
hence,  I  offer  no  excuse  or  apology  for  aught  I  may  say  on 
a  subject  with  which  I  have  taken  especial  pains  to  famil- 
iarize myself.  Having  in  a  measure  established  my  iden- 
tity, I  am  more  fully  prepared  to  proceed  in  a  more  con- 
genial way. 

In  the  realm  of  thought  there  is  no  monopoly,  and  it  is, 
after  all,  at  the  bar  of  public  opinion  that  a  final  judgment 
must  decide  the  merits  of  my  course. 

The  question  is  not  what  to  teach,  but  whom  to  teach. 
This  may  seem,  at  first  sight,  an  easy  matter  to  determine, 
but  a  more  careful  inquiry  will  show  the  complexity. 

The  platform  of  a  medical  college  is  considered  by  some 
the  only  legitimate  place  from  which  a  medical  man  may 
impart  his  knowledge,  but  here  the  opportunity  is  lim- 
ited, notwithstanding  the  abnormally  great  number  of  these 
institutions.  This,  however,  is  not  the  only  reason.  Med- 
ical colleges  are  becoming  so  numerous,  that  they  should 

(15) 


10  HOME    TREATMENT. 

be  discouraged  by  all  honest  and  high-minded  medical 
men,  because  in  this  country  they  are  private  institutions, 
with  very  few  exceptions,  and  subserve  sinister  purposes,  in 
furthering  the  interests  of  their  promoters  either  as  adver- 
tising schemes  or  money-making  institutions,  or  both. 

Of  course  they  are  incorporated  under  State  laws,  which 
make  them  quasi-public  institutions,  but  the  State  exercises 
no  authority  over  them,  and  their  self-constituted  professors 
conduct  them  to  suit  their  own  private  ends.  They  are 
not  limited  by  law,  nor  is  a  required  course  for  their  stu- 
dents imperative,  so  that  the  public  have  no  guarantee  of 
the  fitness  or  competency  of  their  graduates.  There  is,  also, 
an  unhealthy  rivalry  among  our  colleges  for  students,  im- 
proper material  is  taken  in,  and  correspondingly  poor 
material  is  turned  out;  this  in  turn  causes *a  rivalry  among 
their  graduates  in  making  spoil  of  the  sick. 

Every  self-respecting  and  competent  medical  man  has 
an  utter  contempt  for  these  doctor  mills.  This  will  never 
be  different  in  this  country  until  we  follow  the  plan  of 
European  governments,  and  make  medical  colleges  State 
institutions,  and  their  professors  officers  of  the  State,  with 
liberal  salaries. 

The  medical  press  has  a  comparatively  limited  oppor- 
tunity for  imparting  information  to  the  public,  unless  the 
editor  of  the  secular  press  happens  to  make  a  quotation. 

The  exclusiveness  that  has  characterized  the  learned 
professions  generally,  and  the  medical  profession  particu- 
larly, is  rapidly  passing  away.  Only  half  a  century  ago,  the 
medical  lectures  in  Germany  were  mostly  delivered  in  the 
Latin  language,  and,  while  we  now  often  suffer,  in  listening 
to  medical  lectures  in  bad  English,  the  latter  may  still  be 
the  lesser  evil.  In  fact,  so  great  is  the  deference  to  public 
opinion  in  favor  of  diffusing  knowledge  that  medical  fac- 
ulties court  popular  favor  by  delivering  a  course  of  lectures 
on  medical  subjects,  and  consider  these  the  best-drawing 
card  of  the  institution. 


THE    REASON   WHY.  17 

Information  that  is  not  sensational  nor  untruthful  can- 
not fail  to  do  incalculable  good  to  the  class  for  whom  it  is 
intended,  namely,  our  wives,  mothers,  daughters,  and  sisters, 
so  that  they  may  avoid  errors,  that  entail  suffering  and  dis- 
ease; information  that  will  teach  them  how  to  cure  them- 
selves of  the  commoner  and  simpler  ailments,  and  thus 
avoid  running  to  the  doctor,  who  cannot  always  afford  to 
tell  them  the  truth.     Some  would  not  if  they  could. 

The  Darwinian  theory  is  of  wider  application  than  to 
mere  animal  or  plant  life;  it  extends  itself  to  the  over- 
crowded professions,  and  the  increasing  "struggle  for  ex- 
istence "  in  the  ranks  of  the  profession  makes  men  dishonest 
and  greedy  for  any  opportunity  to  raise  a  fee,  so  that  patients 
are  being  treated  for  diseases  which  are  created  for  them 
by  the  cunning  and  dishonesty  of  their  doctors. 

A  little  common  sense  and  a  knowledge  of  the  elemen- 
tary principles  of  disease  would  be  the  best  protection  against 
these  deceptions;  but,  as  a  rule,  sick  persons  are  inclined  to 
throw  aside  all  good  sense,  and  give  themselves  up  entirely 
to  their  feelings  or  to  their  doctor.  This  is  a  very  wrong 
thing  to  do,  and  opens  the  door  for  all  manner  of  imposi- 
tions. 

The  general  practitioner  of  thoughtful  and  studious 
•habits  finds  that,  in  the  course  of  years,  a  diversified  read- 
ing on  the  different  diseases  which  in  the  routine  of  his 
work  he  is  called  upon  to  treat  makes  him  a  generally  well- 
informed  man,  but  not  a  thoroughly  exact  man,  either  in 
theory  or  in  the  details  of  his  treatment. 

Fifty  to  sixty  years  ago  the  entire  field  of  medicine  was 
comparatively  so  small  that  it  was  easier  for  a  brilliant 
mind  then,  to  comprehend  all  that  was  believed  to  be  known, 
than  it  is  for  the  same  quality  of  mind  to  understand  any 
of  the  subdivisions  of  medicine  to-day. 

Those  were  the  days  of  doctrines  and  rules.  Little  that 
was  absolutely  correct  or  true  was  then  known  about  disease, 
otherwise  such  absurd  theories  as  the  "  dynamization  or 
spirit-like"  influence,  causing  disease  on  the  one  hand,  or 


18  HOME   TREATMENT." 

that  the  "  great  source "  of  chronic  diseases  was  psora,  or 
itch,  on  the  other,  as  Hahnemann  would  have  them  believe, 
could  never  have  gotten  a  foothold. 

These  are  the  days  of  scientific  deductions  from  micro- 
scopical and  physiological  research,  in  laboratories  con- 
nected with  great  universities,  and  the  result  is,  that  any  of 
the  specialties  or  subdivisions  of  medicine  is  as  large  and 
interesting  a  field  as  the  entire  area  was  some  time  ago. 
It  thus  happens,  that  some  thoughtful  persons,  after  years 
of  general  practice,  drift  almost  involuntarily  into  some 
one  department  of  medical  art  and  science.  To  this  they 
become  gradually  wedded,  and  in  it  they  grow  in  knowl- 
edge and  experience  far  beyond  their  previous  anticipations. 
What  they  read  on  the  subject  is  better  understood,  and  new 
ideas  are  constantly  formed,  which  enlarge  the  scope  of  their 
knowledge.  In  this  manner  the  writer  drifted  into  the 
domain  of  diseases  peculiar  to  women,  which  was  as  un- 
happy on  the  one  hand,  as  it  is  interesting  on  the  other,  for 
the  phrase  "diseases  of  women"  has  fallen  into  disrepute 
because  every  superficial  practitioner  professes  to  know  all 
about  them,  and  it  often  is  but  another  name  for  criminal 
abortion. 

But  for  all  that,  there  is  a  legitimate  and  scientific  spe- 
cialty of  women's  diseases.  The  time-serving  specialist  must 
be  exposed  in  every  department  of  medical  science.  Whether 
the  pretender  is  labeled,  a  professor  in  a  college,  or  labels 
himself  through  glaring  newspaper  advertisements,  one  is 
just  as  much  a  catch-penny  as  the  other. 

The  object  of  educating  the  laity  cannot  be  reasonably 
confined  to  a  few  medical  truths,  but  the  perversion  of  the 
truth  must  also  be  understood,  so  that  the  false  can  be  de- 
tected. It  is  necessary  to  point  out  the  dangers  and  frauds 
which  are  the  unhealthy  outgrowths  or  excrescences  of 
established  truths,  and  there  must  be  no  veneering  of  the 
wicked  and  sinful  with  ambiguous  phrases  to  shield  the 
guilty;  the  truthful  and  innocent  require  no  apologist. 

The  honest  observer  can  pursue  no  middle  way  in  a 


THE    REASON    WHY.  10 

Avork  to  which  he  has  devoted  the  best  years  of  a  studious 
life,  and  hence  he  may  seem  radical  in  his  opinions.  While 
policy  often  dictates  a  conservative  course,  that  which  con- 
science and  reason  dictate  to  be  true  is  prompted  by  loftier 
motives,  namely,  to  subserve  the  highest  purpose  of  moral 
integrity. 

It  has  often  been  said  that  this  is  a  mechanical  age. 
How  true  is  this  even  in  the  furtherance  of  science !  How 
true  is  this  of  the  science  of  astronomy,  which  was  revolu- 
tionized by  the  construction  of  good  telescopes!  Mechanical 
genius  has  perfected  a  lens  for  Mount  Hamilton  thirty-six 
inches  in  diameter,  and  one  is  now  in  course  of  construction 
for  Mount  Wilson,  in  Southern  California,  which  is  to 
measure  forty  inches.  Through  these  means  scientists  hope 
to  decipher  the  complexion  of  remote  planets. 

Microscopic  lenses  have  been  equally  perfected,  and,  by 
means  of  achromatic  condensers  and  immersion  lenses, 
great  magnifying  power  can  be  obtained  with  perfect  dis- 
tinctness. That  this  mechanical  spirit  of  the  age  should 
also  have  obtained  a  foothold  in  medical  art  and  science, 
is  but  natural.  Surgical  and  other  mechanical  methods 
have  entered  so  boldly  into  the  field  of  diseases  of  women 
that  the  writer  feels  constrained  to  sound  a  note  of  alarm. 
Great  strides  have  been  made  in  a  more  perfected  technique 
in  abdominal  operations,  and,  by  favorable  recoveries  from 
grave  and  severe  operations,  the  field  of  surgical  usefulness 
became  enlarged,  but  this  has  degenerated  into  a  license 
for  notoriety  and  personal  aggrandizement  of  not  over- 
scrupulous and  selfish  surgeons  who  are  over-anxious  to 
■operate  so  as  to  be  able  to  boast  of  the  great  number  of 
their  capital  operations,  or  laparotomies. 

I  was  enthusiastic  in  abdominal  and  pelvic  surgery,  but 
not  until  I  entered  the  field  as  a  specialist  in  this  depart- 
ment of  medicine  did  I  see  and  hear  of  daily  abuses  and 
misuses  of  this  branch  of  surgery.  In  many  instances  it 
■degenerated  into  criminal  malpractice.     It  will  be  instruct- 


20  HOME    TREATMENT. 

ive  information  to  cite  a  few  cases  which  occurred  under 
my  observation,  and  present  the  actual  facts  to  the  reader. 

It  was  in  the  month  of  February,  in  the  year  1888,  that 
a  business  trip  to  the  southern  part  of  the  State  forced  an 
absence  of  several  weeks  upon  me.  Some  two  months  before* 
this  time  I  had  been  called  to  see  a  young  woman,  who  had 
then  been  sick  for  several  months.  She  informed  me  that 
she  had  been  married  nine  years,  and,  not  having  had  any 
children,  she  concluded  to  see  a  noted  specialist  of  female 
diseases.  By  this  physician  she  was  told  that  her  sterility 
was  owing  to  a  closure  or  contraction  of  the  mouth  of  the 
womb.  This  was  obviously  a  wrong  diagnosis,  and  for 
these  reasons:  she  had  always  menstruated  regularly  and 
without  pain,  which  excludes  a  constriction;  and,  secondly,. 
no  physician  can  honestly  call  a  woman  sterile  until  he 
has  examined  her  husband,  who,  in  the  majority  of  in- 
stances, is  the  cause  of  his  wife's  sterility,  because  it  is  ha 
who  is  sterile.  This  woman  and  the  doctor  agreed,  how- 
ever, on  a  course  of  treatment,  which  was  to  forcibly  open 
or  stretch  the  mouth  and  cervical  canal  of  the  womb.  This 
by  itself  is  neither  a  dangerous  nor  a  severe  operation,  if 
carefully  performed,  but  care  in  this  case  was  evidently  not 
exercised,  because  the  young  woman  was  taken  with  severe 
inflammation,  which  caused  a  pelvic  abscess. 

I  found  her  after  two  months  of  suffering.  The  dis- 
charge had  become  extremely  offensive,  her  body  emaciated, 
and  her  strength  exhausted. 

I  enlarged  the  opening  of  the  abscess,  placed  a  large 
drainage  tube  in  the  cavity,  through  which  it  was  washed  out,, 
by  means  of  an  antiseptic  solution  of  bichloride  of  mercury, 
1  part  to  2,000  parts  of  water,  and,  by  further  giving  her 
simple,  nutritious  food,  she  improved  rapidly,  so  that  the 
day  before  I  left  the  city  she  was  at  my  office,  and  told  me 
that  she  felt  as  well  as  ever,  although  not  thoroughly  re- 
covered. I  was  absent  two  weeks,  and  a  few  days  after  my 
return  I  incidentally  met  her  husband,  who  told  me  that. 


THE   REASON    WHY.  21 

a  week  after  I  had  left,  his  wife  felt  unwell  and  called  in 
one  of  her  former  doctors,  who,  by  the  way,  rides  a  hobby- 
horse on  surgery.  This  man  found  a  few  pimples  on  her 
body,  which  can  be  found  on  almost  any  healthy  person, 
these,  he  said,  were  signs  of  blood  poisoning  from  her  ab- 
scess, and  that  an  operation  to  extirpate  the  abscess,  with 
one  or  both  of  her  ovaries,  was  of  urgent  necessity  to  save 
her  life  from  blood  poisoning.  The  deceived  woman  was 
of  course  frightened  into  giving  her  consent  to  the  opera- 
tion, which  was  undertaken  immediately,  and,  as  luck  would 
have  it,  she  recovered;  but  she  might  have  easily  died, 
which  she  undoubtedly  would  have  done  had  this  knife- 
man got  her  sooner,  or  before  I  had  restored  to  her  a  splendid 
physical  condition,  which  withstood  the  unnecessary  butch- 
ery to  which  she  was  induced  to  submit. 

Some  doctors  seem  to  have  a  perfect  mania  for  cutting 
operations,  just  as  though  the  entire  science  and  art  of 
medicine  were  exhausted  in  surgery  alone.  To  assume  this 
for  an  instant  is  manifestly  ridiculous.  More  lives  are  an- 
nually saved  by  a  scientific  application  of  other  methods 
of  cure  than  the  most  elaborate  and  brilliant  statistics  of 
surgery  can  approach.  There  is  science  and  skill  in  select- 
ing proper  medicines,  in  the  employment  of  hygiene  or  the 
rules  of  health,  in  the  practice  of  obstetrics,  and  in  a  variety 
of  other  ways  to  demonstrate  the  triumphs  of  the  art  of 
healing. 

The  rash  and  unnecessary  resort  to  the  knife  has  brought 
surgery  into  general  distrust,  so  that  some  patients  would 
rather  die,  or  wait  until  they  are  almost  dead,  before  they 
allow  an  operation  to  be  performed  on  them,  in  cases  where 
surgery  is,  indeed,  the  only  possible  method  of  cure. 

A  lady  recently  called  at  my  office  for  a  consultation. 
I  found  her  uterus  and  other  pelvic  organs  in  a  perfectly 
healthy  condition,  although  she  suffered  pain  there.  This 
was  due  to  neuralgia  from  a  generally  exhausted  and  de- 
bilitated condition.     I  was  not  a  little  surprised  to  learn, 


22  HOME   TREATMENT. 

from  her  own  lips,  that  she  had  been  treated  for  womb 
disease,  and  was  about  to  undergo  an  operation  for  a  tear  in 
the  mouth  of  her. womb.  This  was  manifestly  absurd,  be- 
cause no  laceration  existed  at  all,  and  if  there  had  it  might 
not  have  been  necessary,  because  it  is  quite  natural  for 
women  who  have  borne  children  to  have  the  scars  of  old 
lacerations  on  the  mouths  of  their  wombs,  and  they  are  not 
any  the  worse  for  them. 

It  is  important  for  mothers  to  know  something  about 
themselves  and  of  the  common  diseases  to  which  they  are 
liable,  for  then  they  will  not  be  so  easily  persuaded  to  per- 
mit the  use  of  caustics,  or  the  cutting,  stitching,  or  scraping 
of  their  wombs,  which  is  quite  likely  to  excite  complicated 
inflammations,  more  serious  in  their  results  than  the  diseases 
for  which  these  operations  were  performed.  I  know  of  what 
I  write,  and  there  is  no  one  who  can  successfully  deny  it. 

Dr.  William  Goodell,  who  stands  as  high  in  the  depart- 
ment of  diseases  of  women  as  any  American,  had  an  article 
in  one  of  the  medical  journals  on  "  The  Abuses  of  Uterine* 
Treatment."  He  says:  "  From  a  large  experience  I  humbly 
offer  to  the  reader  the  following  watchwords  as  broad  helps 
to  diagnosis:  1.  Always  bear  in  mind  what  another  has 
pithily  said,  that  '  woman  has  some  organs  outside  of  the 
pelvis.'  2.  Each  neurotic  case  will  usually  have  a  tale  of 
fret  or  grief,  of  cark  and  care,  of  wear  and  tear.  3.  Scant 
or  delayed  or  suppressad  menstruation  is  far  more  frequently 
the  result  of  nerve  exhaustion  than  of  uterine  disease.  4. 
Anteflexion  of  the  womb,  per  se,  is  not  a  pathological  con- 
dition. It  is  so  when  associated  with  sterility  or  painful 
menstruation,  and  only  then  does  it  need  treatment.  5. 
An  irritable  bladder  is  more  a  nerve  symptom  than  a  uterino 
one.  6.  In  a  large  number  of  cases  of  supposed  or  actual 
uterine  disease,  which  display  marked  gastric  disturbance,  if 
the  tongue  be  clean  the  essential  disease  will  be  found  to  be 
neurotic,  and  it  must  be  treated  so.  7.  Almost  every  sup- 
posed uterine  case,  characterized   by  excess  of  sensibility 


THE    REASON    WHY.  23 

and  by  lack  of  will-power,  is  essentially  a  neurosis.  8.  In 
the  vast  majority  of  cases  in  which  the  woman  takes  to  her 
bed,  and  stays  there  indefinitely,  from  some  supposed  uterine 
lesion,  she  is  bedridden  from  her  brain  and  not  from  her 
womb.  I  will  go  further,  and  assert  that  this  will  be  the 
rule  even  when  the  womb  is  displaced,  or  it  is  disordered 
by  a  lesion  or  disease,  that  is  not  in  itself  exacting  or 
dangerous  to  life.  Finally,  uterine  or  womb  symptoms  are 
not  always  present  in  cases  of  uterine  disease,  nor,  when 
present  and  even  urgent,  do  they  necessarily  come  from 
uterine  disease,  for  they  may  be  merely  nerve  counterfeits 
of  uterine  disease." 

There  is  not  a  physician  of  any  extended  experience 
in  the  land  who,  if  he  be  true  to  his  better  judgment,  will 
not  indorse  every  word  of  Professor  Goodell's  propositions. 
But  the  chances  are  they  will  never  accomplish  the  good 
for  which  they  were  intended  if  the  mothers,  wives,  and 
daughters  are  not  permitted  "  a  little  peep "  behind  the 
curtain,  and  learn  for  themselves.  For  those  who  are 
wealthy  and  have  plenty  of  money,  doctoring  may  be  a 
luxury  or  an  amusement,  but  there  the  line  must  be  drawn 
for  the  benefit  of  the  deserving  poor,  with  whom  any  treat- 
ment is  a  hardship.  Stupidity  of  the  masses  is  one  of  the 
causes  of  the  abuse  of  surgical  treatments,  for  they  always 
look  upon  a  surgical  or  bloody  operation  as  one  of  the 
greatest  achievements  of  modern  medical  art.  Then  there 
is  the  cupidity  of  the  professional  classes,  who  trade  upon 
this  popular  error  and  delusion,  and  charge  correspond- 
ingly large  fees,  which,  as  a  rule,  are  exorbitant,  particularly 
when  the  working  classes  are  the  sufferers. 

A  little  cutting  or  stitching  is  much  more  quickly  done, 
and  the  patient  may  be  dismissed  as  cured,  or  left  under 
the  impression  "  that  everything  was  done  that  could  have 
been  done,"  than  a  conservative  medical  or  hygienic  treat- 
ment, which  involves  more  thought,  labor,  and  patience, 
qualities  which  are  not  as  eagerly  cultivated    as  the  art 


24  HOME   TREATMENT. 

to  wring  out  a  good  fee  by  a  little  surgery,  with  less  labor 
and  skill. 

There  is  not  only  too  much  mischievous  doctoring,  but 
there  is  too  much  of  every  kind,  whether  good,  bad,  or  in- 
different. The  trouble  is  there  are  too  many  in  the  ranks 
of  the  medical  profession;  and  this  is  not  only  true  of  this 
country,  but  is  raising  a  cry  of  warning  in  Europe.  The 
struggle  for  existence  is  a  natural  law,  and  nature  is  immu- 
table. I  do  not  mean  to  say,  that  it  is  a  humane  law,  or 
that  competition  is  a  virtue;  in  fact,  I  believe  quite  the 
reverse.  But  much  that  is  natural  from  a  physical  stand- 
point might  not  be  so  from  a  moral  or  spiritual  plane ;  thus 
the  two  natures  are  distinct. 

It  is  reasonable  to  suppose  that,  if  the  natural  crop  of 
diseases  falls  short  of  supplying  the  demands  of  those  who 
hunger  for  an  opportunity  to  treat  disease,  and  it  lies 
within  their  power  to  create  disease,  they  will  certainly 
do  so.  The  deficiency  must  be  supplied,  or  one  of  two 
things  must  be  done  by  the  doctor :  he  must  either  starve, 
or  go  to  work  at  something  else.  This  may  be  cruel  logic, 
but  I  know  that  these  are  the  actual  facts. 

Now  let  me  ask  how  many  persons  who  have  some  sort 
of  a  diploma  will  be  self-sacrificing  enough  or  sufficiently 
unselfish  to  prefer  to  starve  or  honestly  work  for  a  living, 
if  they  can  avoid  either, by  defrauding  someone  out  of  a  fee, 
for  pretending  to  cure  some  manufactured  disease  ?  It  seems 
almost  a  waste  of  time  to  argue  such  a  self-evident  proposi- 
tion. I  have  known  physicians  of  high  standing  who  treated 
women  for  womb  diseases  which  never  had  a  real  existence, 
and  surgeons  of  large  incomes  to  remove  the  female  breast 
for  a  "supposed  cancer;"  and,  that  being  the  case,  what 
would  you  expect  from  a  less  fortunate  brother  practitioner 
who  is  eking  out  a  miserable  existence  ? 

How  many  a  case  of  simple  sore  throat  or  tonsilitis  is 
being  paraded  as  a  case  of  diphtheria.  Why,  I  know  of 
doctors  who  built  up  their  reputations  in  that  way.     It  is 


THE   REASON   WHY.  25 

quite  an  easy  matter,  to  call  an  ordinary,  simple  case  of 
bronchitis,  pneumonia.  Harmless  swellings,  no  matter 
of  what  sort,  are  treated  and  palmed  off  every  day  as 
cancers.  The  quack  cancer  doctor  is  almost  ubiquitous. 
Some  would  much  rather  part  with  the  village  parson,  or 
their  regular  old  town  doctor,  than  to  part  with  the  cancer 
doctor.  Diseases  that  are  conjured  up  in  the  minds  of  sus- 
ceptible or  hypochondriac  persons  have  for  them  a  real 
existence,  because  if  a  person  believes  he  has  a  certain  dis- 
ease, it  becomes  a  reality,  as  far  as  his  own  state  of  mind 
is  concerned,  and  as  far  as  the  treatment  is  concerned  to 
him  who  created  the  delusion,  it  is  much  more  desirable 
than  if  the  disease  were  real,  because  you  can  cure  an  im- 
aginary disease,  which  may  be  impossible  when  a  real  one 
comes  under  treatment.  This  is  another  method  of  making  a 
reputation  for  extraordinary  cures  that  really  never  occurred. 

When  I  contemplated  writing  a  book,  which  I  hoped 
to  make  a  vade  mecum  for  those  who  felt  interested  in  the 
subject,  I  felt  that  it  would  be  a  duty  which  I  should  reluc- 
tantly perform,  for  it  would  be  a  criticism  on  the  status  of 
the  medical  profession  of  this  country.  I  was  convinced 
that  whatever  I  said  that  would  lower  the  tone  of  the  pro- 
fession in  the  estimation  of  my  countrymen  would  naturally 
reflect  on  me  as  unfavorably  as  upon  any  other  member, 
for  I  never  claimed  to  be  anything  else  but  an  American 
physician,  and,  as  such,  I  have  an  ambition  to  elevate  the 
rank  and  file  to  honor  and  respectability. 

There  is  also  a  motive  that  underlies  a  work  of  this 
nature  which  should  appear  justifiable  to  the  author.  It 
is  absolutely  necessary  that  side-lights  should  be  thrown 
into  dark  corners  and  recesses  that  are  usually  screened  from 
public  notice.  If  there  is  a  growing  deterioration  in  meth- 
ods of  proficiency  and  morals,  the  public  should  know  it,  for 
who  is  the  greater  villain,  he  who  trifles  with  human  life 
through  officious  ignorance  and  venturous  operations,  or  the 
midnight  assassin,  Who,  under  cover  of  darkness,  waylays 


26  HOME   TREATMENT. 

his  unwary  victim?  The  title  "doctor,"  from  the  Latin 
doceo,  "  I  teach,"  has  a  halo  of  learning  that  it  derives  from 
the  original  significance  that  was  attached  to  it  when  it  was 
first  sanctioned  at  Bologna  University,  about  the  middle  of 
the  twelfth  century,  where  it  first  passed  into  the  faculty  of 
divinity.  It  was  afterwards  introduced  into  the  universities 
of  Northern  Europe,  and  remained  ever  since  a  degree  of 
distinction  in  theology,  law,  philosophy,  and  medicine.  In 
the  German  universities  doctor  implies  also  a  license  to  teach 
within  the  university,  as  a  privat-docerd. 

When  we  now  consider  that  no  person  can  matriculate 
in  a  German  university  who  has  not  graduated  from  the 
gymnasium  or  high  school,  it  is  clear  that,  under  the  above 
conditions,  the  title  "  doctor  "  guarantees  that  the  possessor 
is  an  educated  person,  not  only  of  the  high  school,  but  added 
thereto  is  the  accomplishment  in  the  specialty  of  which  he 
holds  the  doctor  degree. 

What  may  a  "doctor  degree"  mean  in  this  country? 
The  title  of  an  illiterate  and  utterly  incompetent  person, 
who  was  by  natural  environment  and  occupation  a  teamster, 
saloon  keeper,  barber,  tailor,  or  patent-medicine  vender,  etc. 

If  a  woman,  she  may  be  retraced  to  an  ignorant  nurse, 
midwife,  or  quacksalver,  the  conceited  wife  of  a  man  who 
indulges  her  in  the  freak  of  "  learning  to  be  a  doctor,"  for 
she  had  demonstrated  her  genius  for  the  profession  by  suc- 
cessfully treating  a  case  of  measles,  which  started  the  doc- 
tor's bee  a-buzzing  in  her  bonnet,  until  she  passed  through 
a  medical  college;  last,  but  not  least,  are  the  winsome 
daughters  of  the  millionaire  or  successful  business  man, 
who  imagine  themselves  too  smart  to  make  useful  house- 
wives and  good  mothers. 

There  is  not  a  medical  college  in  this  State,  and  there  are 
few,  if  any,  in  the  United  States,  that  would  not  eagerly 
take  in  all  of  this  material,  and  guarantee  to  them  before- 
hand, that  they  can  graduate  as  medicinse  doctor  in  twelve 


THE    REASON   WHY.  27 

months  to  three  years,  a  five  months'  course  being  consid- 
ered a  year. 

The  above  comparison  is  a  disgraceful  commentary  on 
the  degree  of  doctor  in  this  country,  and  the  public  should 
learn  to  know  the  difference. 

"  The  United  States  and  Its  Doctors  "  is  the  title  of  an 
editorial  in  the  July  number  of  the  New  York  Medical 
Record,  and  it  says:  "There  is  certainly  no  more  curious 
social  phenomenon  than  that  of  the  extraordinary  popu- 
larity of  the  medical  profession  in  this  country  as  a  means 
of  securing  a  livelihood. 

"  This  subject  is  one  that  is  often  dwelt  upon,  but  we 
doubt  if  many  even  yet  realize  the  grotesque  misproportion 
which  medicine  in  the  United  States  holds  to  other  bread- 
winning  occupations.  Here  are  some  of  the  naked  facts  in 
the  matter: — 

"France  has  38,000,000  of  population,  11,995  doctors, 
while  it  graduates  624  medical  students  in  one  year.  Ger- 
many has  45,000,000  of  population,  about  30,000  doctors, 
and  graduates  935  students  in  one  year.  The  United  States 
has  about  60,000,000  of  population,  100,000  doctors,  13,- 
091  medical  students,  and  graduates  3,740  students  in  one 
year. 

"  Germany,  which  has  relatively  less  than  half  as  many 
doctors  as  America,  is  already  groaning  over  its  surplus. 
When  one  compares  France  with  this  country,  the  excess  of 
medical  men  here  seems  most  astonishing. 

"A  comparison  of  the  United  States  with  Europeon  coun- 
tries, in  whatever  way  it  is  made,  leads  one  to  think  that 
there  is  something  almost  alarming  in  our  medical  pro- 
ductiveness." 

In  connection  with  the  above  comparison,  in  which  it  i3 
shown  that  Germany  has  proportionately  less  than  half  a3 
many  doctors  as  the  United  States,  it  will  be  interesting  to 
learn  the  views  of  the  German  profession.  The  Berlin  cor- 
respondent of  the  Medical  Press  writes  that  the  "  Deutchcr 


28  HOME   TREATMENT. 

iErztebund,"  Society  of  German  physicians,  felt  it  to  be  their 
duty  to  warn  the  guardians  of  young  men  studying  in  the 
gymnasiums  or  high  schools,  against  entering  the  medical 
profession,  the  state  of  overcrowding  being  so  great  as  to 
insure  disastrous  consequences.  In  glancing  over  the  above 
figures,  there  is  one  very  important  point  which  is  greatly 
in  favor  of  the  German  profession  and  militates  against 
the  Americans.  It  is  the  enormous  patent-medicine  trade 
and  quacking  that  is  done  through  it  in  the  United  States; 
on  the  whole,  this  has  been  calculated  to  amount  to  at  least 
fifty  per  cent  of  all  the  doctoring  that  is  done ;  that  means, 
that  where  one  hundred  doctors  now  practice  for  a  living, 
fifty  more  could  make  a  similar  living,  were  it  not  for  the 
patent  and  quack  medicine  trade,  which,  in  some  of  the 
German  States,  is  almost  prohibited,  and  in  others  I  know 
it  is  entirely  inhibited. . 

When  the  Society  of  German  physicians  warns  the  Ger- 
man people  that  an  overcrowding  "  insures  disastrous  con- 
sequences," what  does  it  mean  ? 

This  is  a  question  which,  we  presume,  was  answered  in 
Germany,  and  it  is  certainly  worth  our  while  that  we  should 
answer  it  here,  and  in  this  we  have  decidedly  the  advantage, 
because  in  that  country  the  answer  was  entirely  based  upon 
what  was  anticipated,  while  in  this  we  can  answer  from  what 
we  have  already  realized,  namely,  disastrous  consequences 
to  honor  and  to  integrity  on  the  one  side,  and  to  health  and 
security  against  imposition  on  the  other.  To  this  I  have 
already  referred.  Everyone  competent  of  judging,  and  who 
has  lived  in  that  country,  knows  from  study  and  observation 
that  the  arrangements  and  conveniences  there  for  treating 
the  sick  are  in  a  much  higher  state  of  perfection  than  with 
us.  Hospitals  and  physicians  are  as  accessible  to  all  classes 
as  the  most  humane  and  philanthropic  heart  can  desire, 
and  now  we  learn  that  if  this  wholesome  state  of  affairs 
shall  continue  with  less  than  half  the  proportion  of  doctors 
that  we  have  here,  there  must  be  no  further  increase  of 


^  THE   REASON   WHY.  29 

physicians,  or  it  would  insure  disaster.  This  statement  and 
warning  a  close  and  careful  observer  clearly  appreciates. 
The  writer  was  personally  acquainted  with  a  large  number 
of  German  practitioners  while  in  that  country,  and  knows 
as  an  actual  fact  that  while  their  fees  were  and  are  much 
smaller  than  anything  ever  paid  in  this  country,  they  had 
not  overmuch  to  do,  and  were  only  leisurely  employed.  This 
applies  to  some  of  the  greatest  and  world-renowned  medical 
professors,  as  well  as  to  the  ordinary  general  practitioners. 
But  there  is  a  reason  for  all  this,  too.  These  men  as  a  rule 
are  honest,  they  are  no  money  grabbers,  they  are  thoroughly 
competent  and  scientific  and  manufacture  no  diseases  to 
suit  emergencies  nor  conjure  up  complaints  that  have  no 
real  existence.  If  their  number  were  doubled,  if  the  normal 
proportion  were  disturbed,  the  disaster  would  surely  follow, 
professional  demoralization  would  ensue.  So  the  German 
profession  sounds  a  timely  note  of  warning  ere  the  canker 
of  selfishness  has  destroyed  the  noble  altruistic  principles  of 
physicians,  without  which  the  doctor  is  as  likely  to  be  a 
messenger  from  hell  as  a  ministering  servant  from  heaven. 
Medical  legislation  in  this  country  has  been  nothing  less 
than  a  farce,  partly  because  the  general  public  is  not  aware 
how  abased  the  profession  is,  and  partly  that  Americans 
are  extremely  jealous  of  what  they  term  personal  liberty. 
It  is  being  attempted  to  remedy  some  of  the  abuses  of  the 
medical  profession  by  regulating  the  practice  of  medicine 
by  State  Examining  Boards.  Experience  has  demonstrated 
that  these  boards  are  but  the  excrescences  of  the  various 
medical  colleges,  who  are  themselves  the  root  of  the  very 
evils  that  are  sought  to  be  remedied.  The  duties  of  these 
boards  are  simply  to  make  themselves  officious,  and  to  in- 
quire into  the  source  of  the  credentials  or  diplomas  of  the 
applicants  for  a  license  to  practice  medicine,  and  not  into 
the  qualifications  or  competency  of  the  applicants.  All  that 
is  necessary  under  such  laws  is  simply  to  present  a  diploma 
of  some  sort ;  whether  it  was  stolen,  or  the  diploma  of  a  dead 


30  HOME   TREATMENT.  * 

man,  or  gotten  from  any  of  the  numerous  worthless  colleges, 
is  not  made  the  subject  of  inquiry ;  and  as  by  far  the  greatest 
number  of  quack-salvers  in  this  country  have  diplomas,  the 
law  falls  short  of  remedying  quackery. 

There  are,  usually,  enough  boards  of  examiners,  represent- 
ing the  different  schools,  so  that  the  different  interests  of  the 
diploma  manufacturers  are  well  represented.  A  medical 
examining  authority  whose  functions  and  powers  do  not 
go  higher  or  beyond  the  mere  granting  of  licenses,  or  which 
does  not  examine  into  the  qualifications  of  the  persons  who 
possess  diplomas,  is  utterly  absurd,  because  it  is  no  protec- 
tion against  ignorance  and  imposition.  A  law  that  pre- 
sumes that  all  persons  holding  diplomas  are  qualified  and 
competent  to  practice  medicine,  is  essentially  wrong,  or 
inadequate  to  fulfill  the  purpose  for  which  it  was  designed. 
I  have  known  graduates  from  what  were  considered  good 
colleges  who  could  neither  write  a  safe  prescription  nor  diag- 
nose a  case. 

There  is  only  one  way  towards  an  approach  to  an  efficient 
and  intelligent  board  of  medical  examiners,  and  that  is,  one 
single  State  board  in  which  the  different  schools  may  be 
represented  as  to  their  pet  theories  of  prescribing  medicines, 
but  in  all  other  departments  of  medical  science  and  art 
there  must  be  a  uniformity  of  talent  and  qualification. 

There  must  be  a  standard  of  excellence  established  by  the 
State,  which  is  higher  than  and  above  the  recognized  stand- 
ard of  any  medical  college,  for  no  medical  college  is  trust- 
worthy in  this  respect. 

The  State  in  its  sovereignty  must  prescribe  what  shall 
constitute  a  medical  education,  and  the  requirements  should 
be  embodied  in  the  statutes.  A  license  or  degree  from  that 
source,  after  a  final  examination,  should  be  the  only  legiti- 
mate license  to  practice  medicine. 

Such  a  method  would  establish  a  system  that  would 
clearly  define  the  status  of  ever}'  medical  practitioner.  The 
board  must  have  the  power,  and  it  must  be  their  duty,  to 
examine  each  and    every    applicant  for  a   license,  as   all 


THE   REASON    WHY.  31 

candidates  for  the  army  medical  service  are  examined.  All 
this  noise  and  talk  about  a  preliminary  examination  and 
an  extended  course  of  medical  study  are  simply  the  vaporings 
of  superficial  minds.  It  is  neither  the  preliminary  course, 
nor  the  length  of  time  that  a  person  consumes  in  trying  to 
become  a  doctor,  in  which  the  public  is  interested,  but  what 
kind  of  doctor  a  person  is  when  he  hangs  out  his  shingle 
and  begins  to  practice,  whether  he  is  competent  to  do  that 
which  is  expected  from  him  in  the  hour  of  sickness  or  great 
peril,  irrespective  of  any  diploma  or  any  medical  college. 
Foreign  graduates  should  be  amenable  to  the  same  exam- 
ination, for  behind  these,  too,  belongs  the  interrogation 
point.  The  gushing  mediocrity  of  some  of  these  diploma 
holders  gives  rise  to  the  suspicion  that  their  credentials  are 
not  genuine. 

As  an  American  to  the  manor  born,  I  would  not  for  a 
moment  deny  the  humblest  citizen  an  opportunity  to  ele- 
vate himself  to  the  highest  professional  honors;  but  why 
can  he  not  be  required  to  thoroughly  equip  himself  and 
prove,  by  oral  and  written  examinations  on  subjects  of 
preliminary  education,  that  his  mind  has  become  disciplined 
for  broader  or  special  studies,  irrespective  of  any  course  in 
a  college?  After  the  State  has  satisfied  itself  of  the  profi- 
ciency of  the  applicant  in  scholastic  acquirements,  it  should 
go  further,  and  examine  into  the  qualifications  for  a  degree 
of  medicine,  just  as  they  do  in  the  U.  S.  Army,  only  with 
this  exception,  that  no  diploma  of  any  medical  college 
should  be  required  from  the  candidate,  and  if  he  has  one  it 
should  not  be  recognized. 

This  would  simply  incorporate  in  the  State  laws  the 
distinctive  feature  of  the  University  of  London,  which  ex- 
amines and  confers  graduation  on  persons  who  have  received 
instruction  in  such  institutions  at  home  and  in  the  colonies 
as  have  satisfied  a  Secretary  of  State  with  regard  to  their 
studies. 

This  university  also  has  and  exercises  a  power  of  exam- 
ining for  degrees  persons  who  have  not  been  at  any  institu- 


32  HOME   TREATMENT. 

tion.  Nothing  could  be  more  democratic  than  for  the  State 
to  make  such  a  provision  for  State  medical  examinations. 
The  German  Government  does  precisely  the  same  thing, 
with  the  exception  that  it  makes  graduation  from  the  med- 
ical department  an  essential  prerequisite.  It  has  a  State 
board  of  examiners  to  examine  all  graduates  in  medicine 
of  their  own  universities,  to  further  prove  if  they  are  really 
qualified.  A  diploma  in  Germany  is  of  no  value ;  it  is  the 
so-called  serzliche  Approbationspruefung,  State's  examination, 
that  gives  the  license  to  practice  legally. 

When  this  is  found  necessary,  notwithstanding  the  high 
standard  of  German  medical  schools,  how  much  more  is  this 
safeguard  against  incompetency  needed  with  us  ?  I  have 
endeavored  to  prove  from  the  methods  of  Germany  and  the 
course  of  the  United  States  medical  department  that  di- 
plomas cannot  be  accepted  as  bona-jide  evidence  of  a  medical 
education.  With  us  a  half  dozen  doctors  can  get  together 
any  time,  incorporate  a  medical  college,  call  themselves  pro- 
fessors, and  start  out  advertising  themselves  and  their  col- 
lege for  the  purpose  of  manufacturing  diplomas  and  doctors. 
Why,  a  diploma  under  these  conditions  should  not  be  worth 
the  parchment  it  is  written  on,  as  evidence  of  a  medical 
education,  unless  attested  by  a  higher  and  perfectly  inde- 
pendent authority ! 

If  the  public  once  understood  that  too  many  doctors  are 
dangerous  to  the  morals  and  health  of  society,  they  would 
be  quite  as  anxious  as  the  most  enthusiastic  medical  edu- 
cator to  remedy  the  evil. 

The  question  of  too  many  doctors  is  one  of  economical 
and  social  science,  not  of  medical  science,  and,  therefore,  it  can 
only  be  intelligently  considered  from  these  philosophical 
standpoints.  It  is  a  well-understood  and  accepted  law  of  po- 
litical economy  that  in  the  industrial  pursuits,  whether  in  the 
manufacturing  departments  or  in  agricultural  production, 
the  surplus  or  glut  in  the  market  of  any  of  the  products  of  in- 
dustry, reduces  the  price  and  stimulates  consumption,  which, 


THE    REASON    WHY.  33 

in  the  course  of  time,  is  regulated  by  a  suspended  or  reduced 
production,  thus  restoring  a  healthy  equilibrium.  It  would 
be  an  absurdity  to  apply  the  same  rule  to  a  surplus  of  doc- 
tors, because  human  ills  or  diseases  do  not  increase  in  pro- 
portion to  the  surplus  of  doctors,  nor  will  fees  be  any  less. 
But  the  surplus,  in  order  to  live,  must  live  on  the  earnings 
of  the  community,  and  here  the  disastrous  consequences 
appear. 

The  credulous,  and  those  who  often  may  imagine  that 
they  require  medical  advice,  become  the  unconscious  victims 
of  the  unhealthy  disproportion,  for  the  doctor  seizes  the  op- 
portunity to  make  a  case,  while  the  normal  proportion  of 
cases  do  not  reach  around.  Thus,  it  is  calculated  that  at 
least  fifty  per  cent,  of  all  the  diseases  for  which  patients  are 
treated  are  fictitious  as  far  as  actual  disease  is  concerned,  and 
the  remaining  fifty  per  cent,  are,  in  the  majority  ef  instances, 
overdosed  and  overdoctored.  For  this  reason  medical  legis- 
lation would  not  make  a  privileged  class  of  physicians,  nor 
throw  unusual  safeguards  around  medical  practitioners,  but 
medical  legislation  is  to  protect  the  people  themselves  from 
imposition  and  quackery. 

The  reason  for  the  overcrowded  state  of  the  profession  is 
not  alone  the  laxity  of  medical  laws,  or  the  low  standard  of 
medical  education  in  most  of  our  colleges,  but  the  general 
tendency  of  the  country  population  to  drift  into  the  cities. 
Honest  labor  has  not  the  dignity  which  its  importance  de- 
mands, and  a  radically  faulty  method  of  common-school  edu- 
cation is  another  reason.  Utilitarian  manual  methods,  in 
which  the  hands  are  educated  for  useful  employment  and 
the  minds  to  habits  of  industry,  are  to  be  wished  for.  Young 
men  who  have  acquired  a  technical  education  in  mechanics 
and  arts  will  learn  to  respect  labor  in  every  department, 
and  their  ambition  in  life  will  be  greater  than  to  swing  a 
cane  or  wear  a  silk  tile. 

In  proportion  as  the  productive  employments  are  made 
respectable,  this  questionable  ambition  to  become  M.  D.'s  will 
fall  off.  q 


34  HOME    TREATMENT. 

History  tells  us  that  the  opulence  of  Rome  was  speedily 
accompanied  by  a  decline  of  its  agriculture,  after  which 
came  the  fall  of  the  Roman  Empire,  because  the  country 
population  became  too  indolent  and  restless  and  flocked  to 
the  cities  for  an  easier  and  luxurious  living.  History  in 
this  respect  seems  to  be  repeating  itself.  We  are  always 
talking  of  encouraging  the  beauty  and  growth  of  our  cities, 
but  not  one  word  of  encouraging  agriculture ;  no  one  talks 
of  encouraging  farm  life  and  making  it  profitable  and  attract- 
ive, so  that  men  and  women  would  prefer  the  more  inde- 
pendent subsistence  in  the  country  to  a  shabby  gentility  in 
the  city.  Some  reader  may  ask,  What  has  all  this  to  do  with 
doctoring  ?  I  say  that  the  answer  must  already  have  been 
apparent ;  it  becomes  the  duty  of  everyone  to  interest  him- 
self, that  the  division  of  labor  shall  be  apportioned  so  as  to 
do  the  greatest  good  to  society. 

We  have  a  national  characteristic  which  shows  itself  in 
an  abnormal  conceit  for  everything  American  in  a  degree 
that  is  not  essential  for  true  patriotism  and  love  of  country. 
But  when  by  comparisons  we  learn  that  there  are  abuses 
and  errors  which  are  destructive  to  a  healthy  intellectual 
and  material  growth,  we  must  have  the  honesty  and  inde- 
pendence to  acknowledge  them,  and  busy  ourselves  to  find 
a  remedy  for  existing  evils. 

The  physician  who  can  assist  in  the  amelioration  of 
society  by  administering  to  human  ills  which  are  the  result 
of  unwise  laws,  is  accomplishing  as  much  good  as  if  he 
writes  prescriptions  or  bleeds  patients.  The  sooner  every- 
body recognizes  the  fact  that  the  time  has  come  to  deflect 
the  current  of  ambition  from  the  practice  of  medicine  as  a 
means  of  making  a  living,  the  sooner  will  untold  suffering 
be  lessened,  and  there  is  no  honest-minded  physician  who 
does  not  heartily  agree  with  me.  Mercenary  persons,  and 
ignorant  or  unscrupulous  doctors  who  run  diploma  mills, 
may  criticise  severely  the  honest  sentiments  here  expressed, 
but  the  truth  is  so  apparent,  that  he  who  runs  may  see 


THE    REASON   WHY.  35 

the  inevitable  consequence  of  this  unhealthy  competition. 
Professors  of  colleges  have  a  direct  interest  in  the  ignorance 
and  incompetency  of  their  graduates,  because  they  are  the 
means  of  calling  them  into  consultation  on  every  possible 
occasion  in  trifling  ailments,  and  if  the  disease  belongs  to 
some  specialty,  they  have  the  cases  entirely  turned  over  to 
them,  because,  in  the  mind  of  the  incompetent  and  newly- 
made  doctor,  the  professor  who  was  the  means  of  getting 
him  a  diploma,  poses  as  the  beau  ideal  of  medical  wisdom. 
In  this  way  it  becomes  exceedingly  profitable  to  be  a  pro- 
fessor. If  there  are  not  enough  medical  colleges  in  a  com- 
munity to  afford  places  for  the  ambitious,  it  is  considered  to 
be  one  of  the  best-paying  financial  investments  for  a  com- 
pany of  physicians  to  start  one,  and  in  most  of  these  con- 
cerns it  is  easier  to  get  a  diploma  as  a  doctor  than  to  learn 
to  be  a  good  dressmaker  or  shoemaker. 

Hence  there  is  only  one  remedy  to  control  the  educa- 
tional aspect  of  this  evil,  and  that  is  to  take  medical  colleges 
entirely  out  of  the  hands  of  private  individuals  and  make 
the  State  the  only  source  of  the  necessary  credentials  to 
practice  medicine. 

An  American  system  of  medical  education  fostered  by 
the  State  would  be  productive  of  grand  results,  because, 
tinder  the  shadow  of  our  free  institutions,  the  mind  tran- 
scends the  circumscribed  sphere  of  despotism.  This  has 
already  been  proven  in  numerous  instances,  notwithstand- 
ing unfavorable  surroundings. 

Forming  the  galaxy  of  great  names  that  illumine  the 
milky  way  of  science,  there  are  none  brighter  than  a  Gross, 
xi  Flint,  a  Sims,  and  some  others.  These  were  great  Ameri- 
can authors  and  physicians,  who  never  pretended  anything 
«lse ;  they  never  dreamt  of  the  Don  Quixotic  escapade  of 
pretending  to  be  American  professors  while  they  appended 
to  their  names  initials  or  abbreviations  of  questionable 
credit  from  foreign  institutions.  The  brilliancy  of  true 
genius  was  their  only  passport  to  fame. 


CHAPTER  II. 

DELUSIONS  AS  TO  THE  CURATIVE  VALUE  OF 
DRUGS. 

Medicines  that  are  sure  cures  for  all  the  diseases  to 
which  humanity  is  heir,  are  not  the  spurious  discoveries  of 
the  quacksalver  and  patent-medicine  vender  alone,  but 
some  very  intelligent  persons  believe  that  if  there  is  not  a 
panacea,  there  is  at  least  a  remedy,  for  every  disease.  In 
cases  where  the  patient  does  not  recover,  they  believe  that 
either  the  disease  was  not  thoroughly  understood  or  the 
medicines  which  were  given  were  not  properly  selected. 

This  is  a  great  error,  because  there  is  no  such  thing  as  a 
specific  or  infallible  remedy  for  any  disease,  and,  on  the 
other  hand,  it  is  quite  possible  that  most  patients,  with 
proper  nursing  and  diet,  would  naturally  recover  without 
any  drugs  or  medicines  whatever.  Outside  of  those  drugs, 
like  ether,  chloroform,  opium,  or  morphine,  that  are  em- 
ployed for  the  purpose  of  deadening  the  sensibility  of  the 
nerves,  so  as  to  render  them  insensible  to  pain,  there  is  not 
another  drug  that  is  absolutely  sure  and  true  in  its  medical 
effects.  Some  few  are  very  useful  at  times,  but  the  great 
bulk  of  medicines  do  much  more  harm  than  good. 

Medicine  in  its  broad  sense  means  a  knowledge  of  the 
cause,  course,  treatment  and  ultimate  results  of  disease. 
The  study  of  medicine  cannot  be  circumscribed  by  dogma 
or  theory,  nor  can  it  be  mastered  in  a  few  short  years  of 
study  at  the  very  best  medical  schools.  It  requires  a  mind 
adapted  by  nature  for  a  plodding  investigation  of  her  laws, 
and  incessant  application,  long  after  the  college  curriculum 
is  ended.  In  fact,  the  student  must  unlearn  much  of  the 
(36) 


DELUSIONS   AS   TO   THE   CURATIVE   VALUE   OF   DRUGS.      37 

stereotyped  lessons  of  the  text-books,  and  this  is  particularly- 
true  of  the  supposed  medicinal  effects  of  drugs,  which  are 
always  exaggerated.  When  physicians  really  have  a  threat- 
ening case,  under  their  observation  and  care,  the  attributed 
therapeutic  action  of  drugs  is  nearly  always  disappointing, 
and  very  often  injurious,  and  they  are  forced  to  let  the  drug- 
ging entirely  alone,  and  bring  their  skill  to  bear  on  meas- 
ures which  support  the  strength  and  vitality  of  the  system, 
so  that  nature  can  effect  a  cure  in  her  own  way.  This 
may  seem  to  some  simple  doctoring,  but  I  can  assure  the 
reader  that  it  requires  the  highest  degree  of  medical  skill, 
notwithstanding  the  droll  sarcasm  of  Voltaire,  that  "medi- 
cal science  is  the  art  of  amusing  the  patient  while  nature 
performs  the  cure."  There  is  neither  skill  nor  much  learn- 
ing required  to  give  an  ordinary  prescription;  that  the  aver- 
age apothecary  could  do  with  the  greatest  exactness.  But 
science  and  medical  skill  can  be  exhausted  in  managing 
and  husbanding  the  resources  of  nature,  in  order  to  effect 
a  cure. 

Medicine  no  longer  stands  alone  as  a  simple  art,  based  on 
theoretical  deductions,  as  it  was  less  than  a  hundred  years 
ago,  but  it  has  become  a  department  of  natural  science,  a 
part  of  the  natural  history  of  the  human  race. 

Disease  is  as  much  a  vital  process  as  health,  only  in  one 
case  the  vital  function  is  perverted,  or  destructive,  while  in 
health  it  is  constructive.  The  germ  theory  of  disease  and 
cellular  pathology  are  clearly  within  the  domain  of  bio- 
logical research,  while  chemistry  has  solved  many  phys- 
iological processes.  Mental  philosophy  has  been  no  less 
serviceable  in  the  department  of  medicine,  by  teaching  the 
wonderful  influence  of  thought  and  emotions  on  the  phys- 
iological functions  of  the  organs. 

A  one-sided  education  is  inadequate  to  appreciate  the 
subject  of  healing  or  teaching.  A  comprehensive  knowl- 
edge of  all  that  bears  on  the  subject  of  health  and  disease 
has  several  important  objects  in  view,  namely,  it  thoroughly 


38  HOME    TREATMENT. 

acquaints  the  doctor  with  all  of  nature's  resources  for  the 
amelioration  or  cure  of  disease;  and  it  gives  him  judgment 
in  all  cases  to  avoid  irreparably  wrong  treatment,  which 
places  obstacles  in  the  road  of  nature's  efforts  to  heal 
spontaneously.  The  quack  or  professional  imbecile  will, 
in  the  ordinary  course  of  diseases,  be  accredited  with  remark- 
able cures;  in  fact,  the  cures  wrought  by  a  quack  or  an 
ignorant  person  are  just  as  welcome  and  valuable  to  the 
patient  interested  as  if  they  were  accomplished  under  the 
advice  of  the  most  erudite  and  skillful  physician,  but  the 
invalid  ran  the  chances  of  malpractice  or  bad  treatment 
at  the  hands  of  the  quack,  which  might  have  cost  him  his 
life,  because  the  incompetent  healer  does  not  know  when  his 
method  of  treatment  does  mischief.  Every  method  of  cure 
may  possess  merits  of  its  own,  which  are  beneficial  when 
the  disease  or  conditions  for  its  employment  are  present, 
whether  this  is  mind  cure,  water  cure,  or  anything  else  that 
you  may  name.  All  that  any  system  of  treatment  can  do 
is  simply  to  stimulate  the  curative  force  of  nature,  which  is 
the  only  first  cause  of  any  cure. 

The  reparative  energy  of  nature  has  never  been  duly 
recognized,  because  the  selfishness  and  pride  of  the  doctors 
will  not  concede  this  as  often  as  they  ought.  The  doctor 
should  be  the  most  useful  as  a  monitor  to  the  sick,  in  guid- 
ing and  controlling  thought  and  conduct,  in  harmony  with 
the  curative  energy  of  nature.  From  this  point  of  view  the 
pretensions  of  anyone  effecting  this  or  that  cure  are  only 
a  delusion,  because  the  doctor  effects  nothing,  he  only  assists, 
guides,  and  directs  towards  effecting  a  cure.  What  this  cur- 
ative force  is  has  by  no  means  been  understood.  Some 
believe  it  identical  with  life  or  vital  action,  which  manifests 
itself  only  in  organized  substances,  but  even  if  we  admit 
this  identity,  we  are  balked  again,  because  we  do  not  really 
know  what  life  is,  any  more  than  we  know  what  electricity 
is.  Descartes  resolved  life  into  matter  and  motion;  this, 
however,  is  rather  the   phenomena   of  life   and   gives  us 


DELUSIONS   AS   TO   THE   CURATIVE   VALUE   OF   DRUGS.      39 

no  idea  of  the  real  essence  of  the  force  that  we  call  life. 
There  is  another  theory,  that  all  life  whenever  or  wherever 
found  is  a  spiritual  force,  ethereal  and  universal.  For  our 
purpose,  the  discussion  of  this  question  has  no  particular 
value,  were  it  not  for  the  fact  that  life,  or  vital  activity, 
wherever  we  find  it  in  organized  substances,  whether  in  the 
lowest  living  thing  or  in  the  highest  type  of  physical  devel- 
opment, is  accompanied  by  or  is  endowed  with  the  natural 
tendency  to  repair  defects  or  injuries  in  that  in  which  it  is 
active. 

Regeneration,  or  the  curative  process  of  nature,  is  always 
the  handmaid  of  vital  activity.  It  is  present  at  the  earliest 
formation  and  division  of  a  cell,  which  constitutes  the  unit 
of  all  organisms.  Just  as  one  brick  is  laid  on  the  other  with 
mortar  or  cement  between  them,  so  as  to  make  a  whole  wall 
of  a  building,  so  are  our  bodies  built  up  of  minute  cells,  one 
added  to  the  other,  with  cement  between  them,  until  the 
entire  structure  is  completed.  There  is  no  tissue  of  the  liv- 
ing body  which  was  not  at  one  time  during  its  existence  a 
cell.  This  curative  force  is'  beautifully  illustrated  in  the 
lower  animals,  where  parts  of  organs  are  replaced  to  a  far 
greater  extent  than  among  warm-blooded  animals. 

Professor  L.  Landois,  in  his  work  on  "Human  Physiology," 
says  that  "when  a  hydra  is  divided  into  two  parts,  each 
part  forms  a  new  individual — nay,  if  the  body  of  the  animal 
be  divided  into  several  parts  in  a  particular  way,  each 
part  gives  rise  to  a  new  individual.  The  planarians  also 
show  a  great  capacity  for  producing  lost  parts.  Spiders  and 
crabs  can  reproduce  lost  feelers,  limbs,  and  claws;  snails, 
part  of  the  head,  feelers,  and  eyes,  provided  the  central  nerv- 
ous system  is  not  injured.  Many  fishes  reproduce  fins,  even 
the  tail  fin.  Salamanders  and  lizards  can  produce  an  entire 
tail,  including  bones,  muscles,  and  even  the  posterior  part 
of  the  spinal  cord,  while  the  triton  reproduces  an  amputated 
limb,  the  lower  jaw,  and  an  eye.  This  reproduction  re- 
quires that  a  small  stump  be  left,  while  total  extirpation  of 


40  HOME   TREATMENT. 

the  parts  prevents  reproduction.  In  amphibians  and  rep- 
tiles the  regeneration  of  organs  and  tissues,  as  a  whole, 
takes  place  after  the  type  of  embryonic  development,  which 
is  by  cell  division,  and  the  same  is  true  as  regards  the  his- 
tological processes  which  occur  in  the  regenerated  tail  and 
other  parts  of  the  body  of  the  earth  worm."  Comparative 
pathological  anatomy  clearly  demonstrates  the  inherent 
curative  power  of  nature,  and  this  is  also  apparent  in  the 
vegetable  kingdom,  and  together  they  deliver  a  lecture  on 
the  "art  of  healing"  from  the  stage  of  creation,  in  silent  and 
modest  language,  but  eloquently  instructive  to  the  thought- 
ful observer. 

The  question  now  naturally  arises  How  far  this  curative 
energy  of  nature  operates  in  warm-blooded  animals,  and 
especially  in  man  ?  The  answer  must  be  that,  while  it  falls 
short  of  reproducing  parts  of  organs  or  even  tissues  in  the 
same  degree  of  perfection  as  in  the  lower  orders,  the  innate 
tendency  towards  regeneration  and  recovery  from  injury 
and  disease  is,  on  certain  lines,  practically  the  same.  There 
is  not  the  slightest  doubt  that  ninety  per  cent,  of  all  cures, 
whether  the  invalid  took  this,  that,  or  the  other  medicine,  or 
whether  the  method  of  treatment  was  homeopathic,  allo- 
pathic, or  mind  cure,  are  entirely  due  to  this  inherent  cura- 
tive energy;  and  the  other  ten  per  cent,  may  have  required 
some  active  remedy,  but  this,  too,  alone,  without  nature's 
healing  force,  would  have  been  ineffectual. 

What  is  ordinarily  termed  mind  cure  is  not  mind  cure 
in  the  sense  that  the  term  implies,  but  it  is  simply  the  mind 
toying  or  playing  with  the  idea  of  a  cure,  for  while  the  mind 
is  thus  engaged,  nature's  energy  is  accomplishing  the  result 
or  cure.  This  is  the  only  rational  explanation,  and  corre- 
sponds with  the  cures  that  nature  is  continually  making  in 
the  lower  orders  of  animals.  If  the  recovery  of  the  sick 
depended  entirely  upon  the  caprice  and  wisdom  of  the 
doctor,  and  not  on  the  reparative  forces  of  nature,  the  race 
would  soon  die  out.     I  fully  recognize  the  fact  that  the  cur- 


DELUSIONS   AS   TO   THE   CURATIVE   VALUE   OF   DRUGS.     41 

ative  force  can  be  stimulated ;  this  may  be  done  through  the 
influence  of  nourishing  food,  alcoholic  stimulants,  a  drug  or 
medicine,  or  through  purely  mental  influences.  No  physi- 
cian can  estimate  how  much  merit  he  can  accredit  to  the 
methods  or  substances  he  employs  in  any  particular  case 
that  recovers,  and  how  much  to  the  lady  physician,  Dame 
Nature.  This  old  lady  doctor  is  ever  active,  and  the  most 
inert  drugs,  employed  or  administered  with  her  assistance, 
have  achieved  wonderful  cures;  this  the  history  of  medicine 
confirms.  The  tar  water  cure  of  Bishop  Berkeley  is  an 
illustration  how  an  inert  substance  is  capable  of  making  for 
itself  an  enviable  reputation  for  curing  ailments,  like  pleu- 
risy, pneumonia,  erysipelas,  asthma,  indigestion,  hypochon- 
dria, and  other  diseases.  This  remedy  had  the  vehement 
indorsement  of  one  of  the  greatest  metaphysicians  of  the 
English-speaking  world,  and  that  the  cures  reported  by  him 
were  genuine  no  one  will  doubt  for  a  moment;  but  the 
bishop,  like  many  of  our  day,  was  determined  to  have  a 
remedy  to  cure  disease,  where  none  was  required,  but  the 
mind  had  to  be  humored,  while  nature  was  actively  repair- 
ing the  disorder.  To-day  almost  everyone  is  satisfied,  that 
the  virtues  ascribed  to  tar  water  by  Berkeley  were  a  delu- 
sion, which  was  shared  by  all  those  who  believed  as  he  did. 
The  AVeapon  Ointment  affords  another  instance  where 
the  credulity  of  the  public  was  supported  by  abundant  facts 
to  prove  the  efficacy  of  the  remedy,  yet  it  was  based  on  the 
wildest  superstition.  This  ointment  was  employed  for  the 
healing  of  wounds,  but  instead  of  being  applied  to  them,  the 
weapon  with  which  the  wound  was  inflicted  was  carefully 
anointed  and  hung  up  in  a  corner,  and  the  wound  was 
washed  and  bandaged  without  the  salve  being  allowed  to 
touch  it.  This  ointment  created  such  a  furor  that  eminent 
medical  men  indorsed  its  virtues  as  a  healing  agent.  An- 
other example  of  superstition  and  charlatanry  was  the 
equally  famous  Sympathetic  Powder,  which,  when  applied 
to  the  blood-stained  garments  of  wounded  persons,  cured 


42  HOME    TKEATMENT. 

their  injuries  even  when  miles  away.  That  dukes  and 
knights  vied  with  each  other  to  obtain  the  secret  of  its 
preparation  and  ingredients  is  a  matter  of  history.  In- 
stances of  delusions  on  medical  subjects  could  be  multiplied 
a  thousand  fold,  but  they  prove  nothing  but  ignorance  and 
superstition  on  the  one  side,  and  the  inherent  all-powerful 
curative  force  of  nature  on  the  other.  While  I  wish  to 
avoid  wounding  the  fastidious  and  sensitive  in  the  matter 
of  their  faith  in  their  cherished  system  of  cure,  I  cannot 
refrain  from  classing  homeopathy  as  a  similar  delusion. 

I  am  glad  to  admit  at  the  outset  that  I  have  read 
Hahnemann's  "  Organon  of  the  Art  of  Healing"  with  a  great 
deal  of  interest  and  some  profit.  I  am  convinced  that  his 
theory  of  infinitesimal  dilutions  is  as  absurd  and  ridiculous 
as  either  the  Weapon  Ointment  or  the  Sympathetic  Powder 
treatment  already  referred  to. 

If  we  consider  the  harsh,  or,  preferably-termed,  heroic 
treatments,  then  in  vogue,  we  need  not  be  surprised  that  the 
pendulum  of  medication  should  have  swung  in  the  opposite 
extreme.  Blood  was  drawn  from  the  already  enfeebled 
body,  emaciated  by  disease;  emetics  were  administered  to 
sensitive  and  inflamed  stomachs,  and  only  aggravated  into 
greater  disorder;  blisters,  or  the  burning  rnoxa,  scorched  into 
greater  agony  the  suffering  mortal,  while  large  doses  of 
drastic  cathartics  depleted  the  waning  forces  of  nature. 
There  was  a  tendency  of  the  medical  profession  about  that 
time  to  entirely  ignore  the  curative  forces  of  nature,  and  to 
attack  disease  as  you  would  a  midnight  marauder,  with  the 
most  powerful  and  dangerous  weapons  at  command;  and 
there  is  no  doubt  that  with  these  powerful  expedients,  disease 
was  destroyed,  but  life  also.  Under  these  conditions  Hahne- 
mann appeared  on  the  scene,  and  I  am  frank  to  admit  that 
he  rendered  suffering  humanity  invaluable  service  by  es- 
pousing a  system  of  cure  which  had  the  merit  of  being 
harmless.  If  we  take  into  account  that  physiological  studies 
were  then  in  their  infancy,  and  that  the  word  "Biologie," 


DELUSIONS    AS    TO    THE    CURATIVE    VALUE    OF    DRUGS.      43 

from  the  Greek  words  which  signify  a  discourse  upon  life 
and  living  things,  was  made  use  of  for  the  first  time  by 
Lamarck,  in  a  work  published  in  1801,  it  will  not  seem 
altogether  strange  that  even  learned  men  were  mystified 
into  beliefs  which,  in  the  light  of  our  present  knowledge  of 
the  subject,  appear  preposterous.  This  was  a  most  oppor- 
tune time  to  fasten  on  the  healing  art  any  doctrine  or 
dogma,  however  absurd,  and  on  this  tide  of  ignorance  and 
superstition,  the  doctrine  of  infinitesimal  dilutions  floated 
into  popularity.  Homeopathy  affords  us  one  of  the  most 
striking  illustrations  of  the  uselessness  of  drugs  in  ordinary 
ailments,  and  conclusively  proves  that  nature  possesses  in- 
herent curative  powers.  Cases  treated  under  this  system 
make  splendid  recoveries,  and  often  much  better  than  when 
the  powers  of  nature  are  opposed  or  weakened  with  nauseat- 
ing drugs  and  poisonous  doses,  prescribed  by  incompetent 
persons. 

Hahnemann  truthfully  observed  that  existing  diseases 
are  liable  to  become  aggravated,  complicated  or  replaced  by 
drug  diseases. 

There  is  no  doubt  of  the  truth  of  this  statement  where 
drugs  are  heedlessly  administered.  When  I  was  a  student 
I  was  told  that  calomel  was  par  excellence  a  babies'  medi- 
cine without  any  qualification.  I  was  credulous  enough 
to  believe  it  and  prescribed  it  for  my  own  children  for  its 
purgative  effect  whenever  it  was  deemed  necessary.  In  later 
childhood,  when  the  second  dentition  set  in,  the  germs  of 
the  permanent  teeth  were  so  injured,  evidently  from  the 
calomel  that  had  been  absorbed  into  the  system,  that 
the  teeth  were  ragged  and  defective.  The  glands  of  the 
neck  were  also  inclined  to  swell  and  suppurate,  and  there  is 
no  doubt  in  my  mind  that  a  great  deal  of  what  is  generally 
supposed  to  be  scrofula  in  young  children,  is  nothing  more 
nor  less  than  a  "drug  disease."  I  believe  that  Hahnemann 
was  cognizant  of  the  potency  of  nature  under  ordinary  cir- 
cumstances to  cure  disease.     I  believe  that  he  absorbed  this 


44  HOME    TREATMENT. 

view  of  the  philosophy  of  healing  from  the  writings  of  Para- 
celsus, which  he  had  studied,  and  from  which  he  drew  his 
inspiration,  but  he  also  appreciated  the  practical  necessity 
that  success  depended  on  satisfying  the  superstitious  belief 
of  the  times,  and  that  consisted  in  offering  some  tangible 
remedy.  Hahnemann  proved  himself  equal  to  the  emergency 
by  formulating  his  doctrine  of  potentizing  drugs  or  medic- 
inal substances  by  reducing  them  to  a  wonderful  degree  of 
minuteness. 

The  preparation  of  these  dilutions  was  directed  to  be 
carried  out  in  a  ceremonial  sort  of  way.  Chalk  from  an 
oyster  shell,  sulphur,  charcoal,  or  any  other  substance,  was 
potentized  by  taking  one  grain  of  the  drug  and  mixing  it 
with  one  hundred  grains  of  sugar  of  milk.  Of  this  mix- 
ture one  grain  was  taken  and  mixed  in  the  same  manner 
with  another  hundred  grains  sugar  of  milk.  This  gave  the 
ten-thousandth  of  a  grain  of  the  drug.  Take  one  grain  of 
this  with  another  hundred  grains  of  sugar  of  milk  and 
the  powder  will  contain  the  millionth  of  a  grain  of  the  sub- 
stance, or  the  first  potency,  which  forms  the  bases  of  other 
dilutions.  This  is  reducing  the  doses  of  any  drug  to  an  ab- 
surdity, and  Hahnemann  was  too  brilliant  a  mind  not  to 
know  this.  It  might  be  mentioned  in  connection  with  these 
dilutions,  that  if  one  grain  of  the  most  powerful  drug,  strych- 
nine, aconitin,  arsenic,  or  any  other  chemical  that  is  known, 
is  mixed  with  six  hundred  grains  of  sugar  of  milk,  one 
grain  of  this  powder,  or  the  one  six-hundredth  of  a  grain  of 
this  substance,  cannot  be  detected  by  any  test  or  chemical  re- 
agent; or,  in  other  words,  the  quantity  of  the  drug  or  chemical 
contained  is  so  small  that  the  most  delicate  chemical  test  fails 
to  show  it;  yet,  in  homeopathy,  the  dilutions  are  carried  to  the 
decillionth  of  a  grain,  from  which  important  medical  effects 
are  expected. 

Drugs  are  physical  agents,  and  if  they  are  diluted  so 
as  to  destroy  their  chemical  or  physical  properties,  it  is  sheer 
nonsense  to  expect  any  physical  result  from  them  on  the 


DELUSIONS    AS    TO    THE    CURATIVE    VALUE    OF    DRUGS.      45 

system.  Chemical  and  physical  facts  conclusively  prove  the 
utter  inertness  of  certain  drugs  either  in  themselves  or  in 
the  manner  in  which  they  are  employed,  and  the  indisputa- 
ble evidence  of  biological  science  demonstrates  the  natural 
curative  tendency  of  nature  observable  in  the  lowest  living 
thing  to  the  highest,  so  that  we  should  stultify  our  reason 
were  we  to  arrive  at  any  other  conclusion  than  that  the 
doctrine  of  this  therapeutic  creed  is  one  of  the  most  irrational 
delusions  that  ever  befogged  the  mental  horizon  of  a  think- 
ing being. 

The  supposed  cures  effected  through  the  employment  of 
the  Weapon  Ointment,  the  Sympathetic  Powders,  the  end- 
less dilutions  of  the  Hahnemann  system,  and,  indeed,  most 
other  remedial  agents  from  any  school  or  source,  whether 
offensive  powders,  mixtures,  or  patent  medicines,  or  the 
more  agreeable  and  tasteless  pellets,  have  but  one  role  to  play, 
that  is,  to  assuage  the  apprehensions  of  the  mind  while 
nature  is  performing  the  cure;  that  is,  to  engage  the 
mind  with  the  thought  or  idea  that  something  tangible  is 
being  done  to  bring  about  a  certain  result. 

If  the  patient  has  pinned  his  faith  to  the  curative  value 
of  mind  alone,  the  mind  is  for  the  time  being  engaged 
with  idea  that  mind  is  performing  the  cure.  This  is  a  de- 
lusion quite  similar  to  the  previous  one,  in  which  medicines 
are  taken,  with  only  this  difference,  that  while  you  pin  your 
faith  on  drugs  in  the  one  case,  you  pin  it  to  mind  cure  in 
the  other. 


CHAPTER  III. 

WHAT  IS  MIND  CURE? 

This  subject  has  given  rise  to  an  endless  variety  of  con- 
tradictory discussions,  and  while  it  has  won  for  itself  fanatical 
devotees  on  one  side,  it  has  been  ridiculed  on  the  other.  This 
is  not  at  all  surprising,  when  an  inquiry  is  made  into  the 
competency  of  the  parties  to  the  controversy.  To  be  in- 
formed in  metaphysical  philosophy,  or  fully  equipped  in 
scriptural  lore,  but  without  a  practical  study  in  the  art  and 
theory  of  medical  science,  precludes  the  possibility  of  pre- 
senting the  theme  in  a  logical  manner,  or  establishing  a  rele- 
vancy between  medical  science  and  mind  cure.  A  medical 
education  that  is  based  on  strictly  physical  characteristics  of 
disease,  as  they  are  studied  at  the  bedside,  or  in  a  microscop- 
ical laboratory,  is  equally  inadequate;  for  the  question  of 
mind  cure  goes  beyond  the  physical  into  the  metaphysical, 
and  not  until  the  operations  of  the  mind  have  been  closely 
followed  to  the  bodily  or  organic  functions,  can  the  intimacy 
of  their  relations  be  thoroughly  appreciated.  Medical  men 
betray  their  incapacity  for  observation  if  they  contemptu- 
ously dismiss  the  subject  of  mind  cure  by  some  superficial, 
disparaging  illustration,  for  there  is  much  more  in  the  sub- 
ject than  is  dreamt  of,  even  in  the  mind  of  the  average 
college  professor. 

"The  mind,"  says  Dr.  W.  F.  Evans,  "can  be  made  the 
plastic  or  formative  principle  of  the  body,  and  that  thought 
can  retard,  pervert,  or  stimulate  and  correct  the  different 
functions  of  the  human  organism."  The  relation  of  spirit 
and  matter  is  very  intimate,  and  some  very  clever  thinkers 
resolve  all  matter  into  spirit,  in  its  ultimate  analysis. 
(46) 


WHAT    IS    MIND    CURE?  47 

Bishop  Berkeley  affirms  this  in  his  "Principles  of  Hu- 
man Knowledge."  In  section  seven  he  says  "there  is  not 
any  other  substance  than  spirit." 

If  we  view  nature  from  a  materialistic  standpoint,  we 
see  only  one-half  of  what  we  think  we  do,  and  even  that 
must  be  very  imperfectly  judged  by  our  senses.  Friedrich 
Wilhelm  Joseph  Schelling  states  the  relation  of  matter  and 
spirit,  in  very  simple  and  plain  words,  so  that  a  child  can 
understand  what  he  says:  "Nature  is  spirit  visible,  and 
spirit,  is  invisible  nature."  This  may  be  illustrated  in  phys- 
ical science  from  what  chemistry  teaches  of  the  physical 
properties  of  the  diamond,  whose  atoms  or  molecules  are  so 
perfectly  continuous  and  closely  aggregated  that  it  forms  one 
of  the  hardest  substances  known  to  physicists.  These  atoms 
of  pure  carbon  may  be  made  to  repel  each  other,  so  that  the 
diamond  assumes  a  gaseous  state,  which  is  imperceptible  to 
our  senses. 

I  am  aware  that  the  definition  of  a  gas  is  not  that  which 
metaphysicians  would  accept  as  applicable  to  spirit,  and 
yet  it  illustrates  the  idea  from  a  physical  standpoint.  It  is 
much  better  to  illustrate  a  question  with  something  with 
which  people  are  generally  familiar.  The  body  and  every 
organ  and  tissue  forming  a  constituent  part  of  it,  is  simply 
the  plain  ordinary  matter  in  motion,  vitalized  by  what  we 
call  life,  and  this  life  principle  is  a  mystery,  and  what  is  true 
of  the  diamond  is  true  of  the  human  body  in  its  entirety. 
If  placed  in  a  crematory,  it  is  reduced  to  a  few  ounces  of 
bone  ash,  and,  with  the  addition  of  a  little  acid,  this  too 
would  soon  disappear  into  invisible  gases,  so  that  the  doc- 
trine of  philosophers,  that  matter  is  spirit,  is,  after  all,  not 
so  far  removed  from  physical  evidence. 

Physiological  science  gives  abundant  proof  that  the  mind 
has  a  powerful  influence  over  the  body.  By  mind  is  meant 
all  that  class  of  mental  phenomena  called  reason,  and  the 
emotions  and  passions.  Doctor  Evans  says  "  the  body  is  in- 
cluded in  the  being  of  the  mind,"  or,  in  other  words,  that 
matter  is  included  in  the  being  of  spirit. 


48  HOME   TREATMENT. 

The  thinking  quality  of  the  mind  is  undoubtedly  the 
mainspring  of  its  action,  of  which  the  formation  of  ideas 
is  the  highest  kind  of  mental  activity.  These  originate 
either  within  the  mind  or  are  brought  within  its  sphere  by 
transformed  impressions  from  without,  but  through  the 
power  of  the  Will  these  are  more  or  less  modified,  and  may, 
indeed,  be  entirely  suspended,  so  that  the  mind  may  become 
entirely  passive  and  not  think  of  anything.  It  is  the  exer- 
cise of  this  Will  power  which  may  make  the  operations  of 
thought  conducive  to  health  or  disease. 

Cogito  ei*go  sum,  "  I  think,  therefore  I  am,"  is  a  maxim  of 
Descartes.  What  we  think  and  give  shape  to  in  thought 
has  for  us  a  real  existence,  and  we  have  it  in  our  power  to 
create  thoughts  that  will  have  either  a  painful  or  pleasur- 
able sensation.  Painful  sensations  have  occurred  to  persons 
by  the  conviction  of  the  existence  of  a  cause  which  would, 
when  present,  have  produced  certain  results.  Of  this  sev- 
eral examples  are  given  in  W.  B.  Carpenter's  physiology: 
"A  clergyman  told  me  that  some  time  ago  suspicions  were 
entertained  in  his  parish  of  a  woman  who  was  supposed  to 
have  poisoned  her  newly-born  infant.  The  coffin  was  ex- 
humed, and  the  coroner,  who  attended  with  the  medical 
men  to  examine  the  body,  declared  that  he  already  perceived 
the  oder  of  decomposition,  which  made  him  feel  faint,  and 
in  consequence  he  withdrew.  But  on  opening  the  coffin  it 
was  found  to  be  empty,  and  it  was  afterwards  ascertained 
that  no  child  had  been  born,  and  consequently  no  murder 
committed."  The  second  case  is  yet  more  remarkable :  'A 
butcher  was  brought  into  the  drug  store  of  Mr.  Macfarlan, 
from  the  market-place  opposite,  laboring  under  a  terrible 
accident.  The  man,  on  trying  to  hook  up  a  heavy  piece  of 
meat  above  his  head,  slipped,  and  the  sharp  hook  penetrated 
his  arm,  so  that  he  himself  was  suspended.  On  being  ex- 
amined he  was  pale,  almost  pulseless,  and  expressed  himself 
as  suffering  acute  agony.  The  arm  could  not  be  moved 
without  causing  excessive  pain,  and  in  cutting  off  the  sleeve 


WHAT   IS   MIND   CURE?  49 

he  frequently  cried  out.  Yet  when  the  arm  was  exposed,  it 
was  found  to  be  quite  uninjured,  the  hook  having  only  trav- 
ersed the  sleeve  of  his  coat."  In  this,  and  similar  cases,  the 
sensation  was  perfectly  real  to  the  individual  who  experienced 
it,  but  it  originated  in  the  mind  by  an  impression  through 
the  nerves  of  internal  sensation  which  created  the  idea 
or  image  in  the  brain,  and  the  external  senses  to  which 
it  was  referred  had  nothing  to  do  in  causing  the  feeling. 
Diseases  are  thus  created  every  day,  either  by  ourselves  or 
by  those  to  whom  we  go  for  advice.  I  call  to  mind  a  lady 
who  had  gone  to  a  distinguished  practitioner  for  a  supposed 
womb  disease  for  some  six  months.  She  experienced  no 
change  for  the  better,  but  kept  on  growing  continually 
worse,  so  that  she  no  longer  had  a  refreshing  sleep,  and  her 
appetite  for  food  was  entirely  gone.  On  examination  I 
found  her  womb  entirely  healthy,  in  fact,  exceptionally  so, 
thanks  to  her  attending  physician,  because,  after  a  certain 
amount  of  useless  doctoring,  the  rule  is  quite  the  other  way. 
I  told  this  lady  of  her  error  or  delusion  respecting  her  womb, 
and  prescribed  a  quieting  mixture  for  the  night  and  a  tonic 
for  the  day.  She  began  at  once  to  improve,  and  when  I 
saw  her  again,  six  weeks  afterwards,  she  had  so  fleshed  up 
that  I  failed  to  recognize  in  her  traces  of  her  former  delu- 
sion. The  disease  of  which  this  woman  was  suffering  was  im- 
aginary, and  had  no  real  existence  for  anyone  outside  of  her- 
self. She  was  the  victim  of  the  harrowing  symptoms  which 
her  mind  conjured  into  shape,  and  an  attempt  to  brush  aside 
the  disease,  with  the  flippant  remark  that  "there  was  noth- 
ing the  matter  with  her,"  would  have  been  cruel,  unscientific, 
and  absurd.  The  ailment  which  she  thought  she  had,  had 
as  much  an  existence  as  though  the  most  malignant  disease 
was  destroying  her  life  ;  for  her  imaginary  disease  was  doing 
the  same  thing,  only  in  a  different  way. 

Imagination  is  the  most  powerful  function  of  the  human 
brain.     Associated  with  thought,  it  constitutes  the  empire 
of  the  soul,  which  recognizes  neither  time  nor  space.     With 
4 


50  HOME    TREATMENT. 

it  we  are  brought  into  communion  with  everything  that  is 
grand  and  beautiful  in  nature.  Imagination  is  the  archi- 
tect of  our  souls;  it  continually  creates  and  projects  into  the 
beyond;  it  enlarges,  the  sphere  of  our  thought  in  building 
up  artificial  structures  for  our  pleasure  and  entertainment. 
When  it  becomes  perverted  and  abnormal  from  false  im- 
pressions, either  through  the  nerves  of  internal  sensation  or 
through  the  nerves  of  external  sense,  or,  what  quite  often 
occurs,  from  morbid  thoughts  or  ideas  received  from  others, 
it  becomes  equally  potent  in  causing  misery  and  disease. 

Expectation  or  attention  influences,  in  a  remarkable  de- 
gree, the  bodily  functions.  There  are  a  great  many  persons 
who  keep  themselves  in  misery  and  disease  by  always  think- 
ing of  their  imaginary  or  real  sickness.  I  had  a  profitable 
experience  some  years  ago  in  my  own  case,  which  conclu- 
sively proved  to  my  mind  the  aggravating  tendency  which 
constant  attention  has  on  disease.  I  had  contracted  an  ordi- 
nary catarrh  of  the  pharynx,  or  what  is  generally  called  a 
sore  throat.  At  first  I  did  not  mind  it,  but  in  the  course  of 
time,  from  continued  exposure  in  all  kinds  of  inclement 
weather,  at  all  hours  of  the  day  or  night,  it  fastened  itself 
upon  me  so  that  it  was  at  times  very  annoying  by  its  dry- 
ness and  pain.  I  do  not  know  of  anything  that  I  did  not 
use,  but,  after  a  trial  of  several  years,  I  was  convinced  that 
the  more  I  looked  at  it  and  the  more  I  treated  it  with  sprays, 
gargles,  etc.,  the  worse  it  became,  so  that  one  day  I  resolved 
to  let  it  alone,  and  not  think  about  it.  I  took  a  teasponful 
of  glycerine  once  in  a  while  when  it  became  too  dry.  For 
years  I  have  not  looked  at  it,  and  for  all  I  know,  it  is  per- 
fectly well.  I  stopped  bundling  up  my  neck,  used  light 
bedcovering,  so  as  not  to  sweat,  and  by  this  simple  method 
accomplished  what  the  very  best  selected  drugs  utterly 
failed  to  do. 

The  great  English  authority,  Daniel  Hack  Tuke,  in  his 
work, "  The  Influence  of  the  Mind  on  the  Body  in  Health  and 
Disease,"  quotes  from  Unzer's  work,  published  in  Germany  in 


WHAT   IS   MIND   CURE?  51 

the  year  1771:  "Expectation  of  the  action  of  a  remedy  often 
causes  us  to  experience  its  operation  beforehand."  And 
John  Hunter  said  as  early  as  178G:  "I  am  confident  that 
I  can  fix  my  attention  to  any  part  until  I  have  a  sen- 
sation in  that  part."  A  great  number  of  cases  are  recorded 
where  complete  insensibility  to  bodily  pain  has  been  induced 
without  the  use  of  drugs.  The  intention  of  administering  a 
certain  drug  was  made  known  in  this  manner.  Bread  pills 
have  acted  as  decided  cathartics,  and  an  empty  chloroform 
or  ether  bottle  put  the  sensitive  into  a  profound  stupor  or 
insensibility. 

Dr.  Woodhouse  Braine,  of  the  Charing  Cross  Hospital, 
-writes:  "During  the  year  1862  I  was  called  upon  to  give 
chloroform  to  a  very  nervous  and  highly  hysterical  girl, 
who  was  about  to  have  two  fatty  tumors  of  the  scalp  re- 
moved. On  going  into  the  operating  room,  it  was  found 
that  the  bottle  containing  the  chloroform  had  been  removed 
to  the  dispensary,  and  on  testing  the  Snow's  inhaler,  which 
.at  that  time  I  was  in  the  habit  of  using,  I  found  it  to  be 
quite  devoid  of  even  any  smell  of  chloroform.  Then,  hav- 
ing sent  for  the  bottle,  in  order  to  accustom  the  girl  to  the 
face-piece,  I  applied  it  to  her  face,  and  she  at  once  began  to 
breathe  rapidly  through  it.  When  she  had  done  this  for 
about  half  a  minute,  she  said,  'Oh,  I  feel  it,  I  feel  I  am  go- 
ing off,'  and  as  the  chloroform  bottle  had  not  arrived,  she 
was  told  to  go  on  breathing  quietly.  At  this  time  her  hand, 
which  had  been  resting  across  her  chest,  slipped  down  by  her 
side,  and  as  she  did  not  replace  it,  I  thought  I  would  pinch 
her  arm  gently  to  see  the  amount  of  discomfort  her  hysteri- 
cal state  would  induce  her  to  bear.  She  did  not  notice  a 
gentle  pinch,  and  so  I  pinched  her  harder,  and  then  as  hard 
as  I  could,  and  to  my  surprise  I  found  that  she  did  not  feel 
at  all.  Finding  this  was  the  case,  I  asked  the  operator  to  be- 
gin, and  he  incised  one  of  the  tumors,  and  then,  as  the  cyst 
was  only  slightly  adherent,  peeled  it  away.  At  this  time  I 
had  removed  the  face-piece,  and,  wishing  to  see  the  effect  of 


52  HOME    TREATMENT. 

her  imagination,  I  said  to  the  operator,  who  was  going  to 
remove  the  second  tumor,  '  Wait  a  minute ;  she  seems  to  be 
coming  round.'  Instantly  her  respiration,  which  had  been 
quite  quiet,  altered  in  character,  becoming  rapid  as  when  I 
first  applied  the  inhaler,  and  she  commenced  moving  her 
arms  about.  I  then  replaced  the  face-piece,  and  her  breath- 
ing again  became  quiet,  and  she  submitted  to  the  second 
operation  without  moving  a  muscle.  When  the  water  dress- 
ing and  bandages  were  applied,  in  answer  to  the  question  as- 
to  whether  she  had  felt  anything,  she  said,  '  Xo;  I  was  quite 
unconscious  of  all  that  was  done.' "  The  mental  phenomenon 
that  we  observe  in  this  case  clearly  shows  how  completely 
the  sensation  of  the  patient  was  suspended  by  the  imaginary- 
chloroform,  which  existed  only  in  her  mind,  yet  the  real 
drug  could  not  have  been  more  potent  in  its  effects. 

Phenomena  of  the  same  mental  process,  like  the  different 
colors  of  the  solar  spectrum  coming  from  one  source,  consti- 
tute the  different  stages  or  degrees  of  what  is  generally 
called  mesmerism  or  somnambulism,  until  the  sensitive  ar- 
rives at  that  condition  of  complete  double  consciousness  now 
commonly  called  hypnotism,  in  which  state  the  will 
power  of  the  person  becomes  entirely  suspended,  so  that  he 
acts  only  from  suggestions  of  another  person,  regardless  of 
propriety  or  consequences.  When  a  subject  who  has  been 
completely  hypnotized  is  restored  to  his  normal  condition, 
lie  remembers  nothing  of  what  has  transpired  during  tho 
somnambulistic  state.  We  all  have  acquaintances  of  whom 
we  speak  as  being  easily  led ;  by  that  we  mean  that  they 
have  no  will  or  mind  of  their  own.  These  persons  are 
truly  unfortunate,  because  they  are  at  the  complete  mercy 
of  every  designing  person  or  cunning  rogue.  They  consti- 
tute the  large  army  of  dupes  who  support  the  great  number 
of  idle  women  and  lazy  men,  who  claim  to  be  clairvoyants, 
life  readers  and  fortune  tellers.  In  sickness  they  are  equally 
as  credulous,  and  when  they  are  a  little  out  of  sorts,  they 
would  a  great  deal  rather  be  told  that  some  dangerous  or  se- 


WHAT    IS    MIND    CURE?  53 

vere  illness  has  hold  of  them  than  to  hear  the  truth  that, 
outside  of  not  eating  properly,  or  clothing  themselves  im- 
properly, or  being  out  late  at  nights  when  they  should  be  in 
their  beds,  there  is  nothing  the  matter  with  them. 

These  are  the  dupes  who  fill  up  the  chairs  in  the  doctor's 
waiting  rooms,  on  regular  days,  for  local  or  special  treatment 
for  diseases  which  could  be  much  better  treated  by  themselves 
at  home,  if  they  only  were  fortunate  enough  to  fall  into  a 
physician's  hands  who  had  the  honesty  to  tell  them  so.  This 
can  be  further  illustrated  by  an  experience  of  which  every 
one  of  us  has  been  a  victim  at  least  once  in  our  lives.  When 
we  were  trying  on  a  pair  of  new  shoes,  we  felt  that  they 
pinched,  or  were  too  short  and  generally  uncomfortable; 
but  the  salesman  insisted  that  they  were  a  "perfect  fit"  and 
that  after  a  little  wearing  they  would  surely  suit.  The 
shoes  were  bought,  and  we  were  convinced,  after  a  few  days, 
that  our  impression  of  the  smallness  of  the  shoes  was  cor- 
rect, because  they  continued  to  pinch  us;  but  we  were  for 
the  time  mesmerized  or  psychologized  by  the  clerk  into  buy- 
ing what  we  were  satisfied  in  our  own  minds  to  be  not  what 
we  wanted.  This  should  be  constantly  guarded  against, 
and  our  conscious  will  power  should  always  be  exercised  on 
all  occasions. 

Parents  should  take  particular  pains  to  cultivate  the 
will  power  of  their  children,  in  the  right  direction,  of  course. 
To  stifle  the  will  of  children,  when  the  exercise  of  it  entails 
no  bad  consequences,  is  wrong,  because  it  weakens  their 
character,-  and  makes  them  the  prey  of  the  wicked  and 
selfish  when  they  are  grown  to  adult  age.  This  influence 
which  one  person  may  exercise  over  another  is  not  due  to 
any  particular  force  or  magnetism,  as  was  supposed  by  Mes- 
mer,  and  which  is  yet  claimed  by  ignorant  frauds  and  pre- 
tenders, but  it  is  simply  a  suspension  of  your  own  ivill,  or  a 
sacrifice  of  force  of  character.  Dr.  J.  M.  Charcot,  of  France, 
has  lately  taken  up  this  subject,  and  has  given  it  a  great  deal 
of  attention.    His  researches  have  confirmed  the  experiments 


54  HOME    TREATMENT. 

and  conclusions  of  Braid,  an  English  surgeon  of  Manches- 
ter, who,  in  1841,  showed  that,  in  order  to  produce  artificial 
somnambulism,  there  was  no  need  of  any  extraneous  influ- 
ence, and  that  any  person  of  moderate  sensibility  can  easily 
produce  in  himself  the  "  magnetic  sleep  "  without  any  aid  or 
act  of  another. 

Braid  discovered  that  to  simply  fix  the  eyes  for  a  few 
minutes  on  some  shining  object,  placed  a  little  higher  than 
the  ordinary  plane  of  vision,  and  five  or  six  inches  from  the 
eyes,  caused  that  total  abstraction  which  Doctor  Braid  called 
"  hypnotism,"  and  which  now,  in  honor  of  the  experimenter, 
is  often  called  "Braidism."  This  Doctor  Charcot  calls  "im- 
personal "  sleep,  artificially  produced  by  mechanical  means. 
He  remarks:  "The  psychic  characteristic  of  the  state  of 
somnambulism  is  an  absolute  trust,  a  boundless  credulity 
on  the  part  of  the  subject  toward  the  one  who  has  hypnot- 
ized him.  Take  one  example  from  among  a  thousand:  I 
present  to  a  woman  patient  in  the  hypnotic  state  a  blank 
leaf  of  paper,  and  say  to  her:  '  Here  is  my  portrait;  what  do 
you  think  of  it?  Is  it  a  good  likeness? '  After  a  moment's 
hesitation  she  answers,  'Yes,  indeed;  your  photograph! 
Will  you  give  it  to  me?'  The  image  being  now  fixed  in  her 
mind,  I  take  the  leaf  of  paper,  with  a  private  mark,  and  mix 
it  with  a  score  of  other  leaves  precisely  like  it.  I  then  hand 
the  whole  pack  to  the  patient,  bidding  her  to  go  over  them 
and  let  me  know  whether  she  finds  among  them  anything 
she  lias  seen  before.  She  begins  to  look  at  the  leaves  one 
after  another,  and  as  soon  as  her  eyes  fall  upon  the  one  first 
shown,  she  exclaims, 'Look!  your  portrait!'"  This  is  the 
latest  phenomenon,  and  proves  how  the  mind  may  print  an 
image  on  a  substance,  as  the  sun  prints  on  a  negative. 

For  persons  of  casual  thought  or  reading,  hypnotism 
may  at  first  appear  complicated  and  mysterious,  but  if  you 
will  only  bear  in  mind  that  the  different  mental  processes 
operating  between  two  persons  always  resolve  themselves 
into  a  weaker  will  power  yielding  and  a  stronger  will  power 


WHAT    IS    MIND   CURE?  55 

controlling,  you  have  a  key  which  unlocks  the  different  man- 
ifestations of  minds  in  their  relations  one  with  the  other. 
This  does  not  relate  to  action  alone,  but  to  the  creation  and 
meaning  of  our  thoughts. 

The  cures  effected  by  the  royal  touch,  which  prevailed 
in  England  from  the  time  of  Edward,  the  confessor,  to  Queen 
Anne,  were  but  a  disguised  hypnotism,  or  a  sort  of  mind  cure. 
Soothsayers,  or  magnetic  healers,  who  claim  a  healing  mag- 
netism, are  either  knaves  or  fools,  and  often  both.  They 
undoubtedly  can  report  cures,  but  these  are  due  to  the  nat- 
ural tendency  of  some  diseases  to  get  well,  and  to  the 
hopeful  thoughts  which  these  persons  inspire  by  their  prom- 
ises of  a  cure;  sometimes  these  hopes  are  heightened  by  the 
different  movements  or  passes  which  the  healer  makes. 
The  greatest  healer  of  whom  we  have  any  reliable  record 
never  claimed  any  abnormal  power  or  force.  Christ  healed 
by  the  Word,  that  means  by  the  thought  or  mind.  Faith 
in  anything  creates  a  curative  or  healing  thought  in  the 
mind  of  the  patient,  which  stimulates  the  reparative  or  heal- 
ing force  of  nature,  and  in  this  manner  wonderful  cures  are 
effected. 

The  faith,  or  confidence,  which  you  have  in  a  physician 
stimulates  you  at  once  into  a  better  or  stronger  feeling. 
This  has  been  the  experience  of  every  sick  person,  but  this 
is  not  due  to  any  power  or  force  that  this  person  possesses, 
which  departs  from  him  and  goes  over  to  you,  but  is 
entirely  due  to  the  confidence,  which  stimulates  your  own 
nerve  centers,  and  especially  the  brain.  The  soothing  and 
quieting  influence  which  the  "Weapon  Ointment"  had  on 
the  injured  person  was  not  due  to  any  virtue  of  this  ointment, 
because  it  was  never  applied  to  the  wound,  but  to  the  weapon 
or  implement  which  caused  the  wound.  Its  operations  were 
entirely  mental  or  psychical.  It  pacified  the  excited  and 
anxious  mind  into  the  faith  or  belief  that  the  best  possible 
thing  to  do  was  being  done,  and  nature  went  on  trium- 
phantly and  effected  the  cure,  for  which,  of  course,  she  never 


56  HOME   TKEATMENT. 

got  any  credit.  When  a  doctor  or  healer  enters  the  cham- 
ber of  the  sick,  putting  on  a  wise  air,  or  indulges  in  affecta- 
tion, and  when  he  succeeds  in  making  a  good  impression,  that 
alone  assuages  the  pain.  But  if,  on  the  other  hand,  he  im- 
presses his  patients  unfavorably,  the  sooner  he  gets  out 
of  their  sight,  the  better  they  feel,  because  his  presence  has 
inspired  neither  confidence  nor  hope. 

Hysteria  constitutes  a  peculiar  group  of  diseases  which 
belong  to  that  class  of  nervous  ailments  that  are  included 
among  functional  affections;  they  are  oftener  amenable  to 
faith  or  mind  cures  than  to  drugs.  A  great  number  of  dis- 
eases of  women  belong  to  this  class  and  these  poor  de- 
luded creatures  never  had  anything  real  or  serious  the 
matter  with  them,  until  they  went  to  some  doctor  who 
began  to  apply  irritating  drugs  to  their  delicate  organs, 
which  made  them  ever  afterwards  habitues  of  doctors'  offices. 

Functional  diseases  have  a  wide  range.  As  their  name 
implies,  they  are  characterized  by  a  disturbance  of  the  func- 
tion of  an  organ  or  system,  without  any  visible  alteration  of 
its  tissue  or  texture;  there  are  no  pathological  or  histological 
changes,  which  the  most  careful  microscopic  examination 
can  detect.  They  constitute  a  scapegoat  for  our  ignorance; 
it  appears  to  be  in  the  majority  of  instances  a  disturbance 
between  the  psychic  or  spiritual  forces  as  they  operate  on  the 
tissues.  The  normal  and  harmonious  relations  between  the 
mind  and  the  body  or  any  particular  organ  are  disarranged. 
Such  are  the  hysterical  convulsions  or  spasms  which  we 
see  in  women  who  have  suffered  great  mental  strain,  es- 
pecially grief,  and  often  it  is  due  to  pure  "cussedness,"  or  un- 
bridled passion.  In  men  there  is  also  a  hysteria ;  it  was  for- 
merly believed  that  this  peculiar  nervous  derangement  was 
confined  to  women  only,  hence  the  name,  but  this  was  an 
error.  I  was  once  called  to  attend  a  physician  of  more  than 
average  ability,  who  located  in  this  city  for  the  purpose  of 
enlarging  his  field  of  labor  and  usefulness;  from  where  he 
came  he  had  been  ver}'  successful.     His  reputation  as  a  sur- 


WHAT   IS    MIND    CURE?  57 

geon  was  enviable  and  deservedly  so,  but  here,  in  this  city, 
among  strangers  and  strange  customs,  he  was  a  failure. 
This  preyed  on  his  mind  so  that  he  became  despondent  and 
gloomy.  He  failed  in  flesh  and  strength.  I  found  him  in 
his  room  convulsively  sobbing,  which  shortly  turned  into  a 
paroxysm  of  laughter.  I  prevailed  upon  him  to  return  to 
his  former  residence  among  his  friends  and  admirers,  which 
he  did,  and  he  told  me  afterwards  that  from  the  moment  he 
struck  his  "old  stamping-ground"  he  felt  stronger  and  bet- 
ter, and  shortly  recovered  his  former  mirth  and  healthful- 
ness. 

Girls  show  this  abnormal  nervous  function  in  different 
ways.  I  have  known  a  case  where  a  sensitive  girl  accidentally 
saw  another  girl  in  an  epileptic  fit;  the  contortions  became 
so  real  and  fixed  in  her  mind,  or  imagination,  that  they  were 
transmuted  into  motions  or  epileptic  fits.  I  tried  remedies 
but  without  any  beneficial  results.  The  parents  afterwards 
went  the  rounds  of  the  "fits  doctors,"  but  with  the  same 
negative  results.  A  Christian  scientist  or  faith  healer  cured 
her,  by  cultivating  or  strengthening  her  will  power. 

There  is  a  class  of  these  faith  healers,  composed  of  silly, 
loquacious  women  and  men,  who  know  nothing  at  all  of  the 
principle  governing  their  cures,  and  they  glibly  tell  their 
patients,  "  You  must  say  or  think  there  is  no  disease,  or  I 
have  no  pain,  or  there  is  no  body;  all  is  well;  all  is  good," 
and  a  great  deal  of  similar  nonsense.  All  is  not  good,  and 
all  is  not  well  by  any  means.  I  would  say,  Indeed  there  is 
pain,  disease,  and  a  body,  but  by  striving  to  live  a  healthful 
moral  life,  and  thinking  healthful  thoughts,  of  the  good,  the 
pure,  and  the  beautiful,  the  curative  energy  of  nature  will' 
become  stimulated  to  repair  the  defects,  to  harmonize  the 
functions  and  dissipate  disease. 

A  person  who  is  troubled  with  dyspepsia  cannot  get  well 
if  he  thinks  of  nothing  but  an  acid  or  sour  stomach,  or 
feels  the  food  disagreeing  with  him  before  he  has  it  in  his 
mouth.    He  must  have  thoughts  quite  remote  from  these, 


58  HOME   TREATMENT. 

and  the  chances  are  nine  out  of  ten  he  will  not  feel  what 
he  eats.  There  is  the  same  state  of  mind  about  "  catching 
cold."  Some  persons  are  forever  on  the  alert  to  catch  a  cold, 
and  why  should  they  not,  when  they  are  always  watching 
out  for  it?  If  you  dress  so  that  you  do  not  sweat,  and  do 
not  use  too  thick  bedcovering,  and  are  not  constantly  on 
the  catch  or  lookout,  I  assure  you  you  will  not  catch  cold, 
nor  will  it  catch  you. 

Terror  or  fright  causes  or  cures  diseases.  Dr.  Toad  re- 
ports the  case  of  a  boy,  in  Tuke's  work,  nine  years  of  age, 
who  was  frightened  into  chorea,  or  St.  Vitus'  dance,  by  his 
sister,  who  had  covered  herself  with  a  white  sheet  and  ap- 
peared before  him  unexpectedly,  while  he  was  in  bed.  I 
know,  also,  a  case  of  functional  bladder  weakness  of  a  child 
who  wet  his  bed  at  night  during  sleep.  There  appeared  no 
signs  of  any  local  disease,  nor  was  any  remedy  which  I  em- 
ployed of  the  slightest  advantage.  The  father  of  the  child, 
becoming  exasperated,  gave  the  child  a  severe  thrashing  one 
morning.  The  mother  remonstrated  at  what  she  considered 
cruel  and  useless  chastisement.  But,  strange  yet  true,  that 
child  never  wet  the  bed  after  that;  it  was  entirely  cured  by 
fright. 

Sympathy  will  often  make  persons  sick;  of  this  I  had  in 
my  own  experience  an  opportunity  for  a  very  interesting 
observation.  It  was  the  husband  of  a  woman  who  had  been 
retching  and  vomiting  incident  to  the  early  months  of  her 
pregnancy.  So  great  was  the  sympathy  of  her  husband  that 
he  retched  and  vomited  exactly  like  his  wife,  not  only  when 
in  her  presence,  but  when  separated  from  her,  the  impres- 
sions or  thought  exciting  the  excito-motor  nerves  of  the  stom- 
ach. This  sympathetic  sickness  lasted  as  long  as  that  of  his 
wife. 

Dr.  H.  C.  Sawyer,  author  of  "Nerve  Waste,"  has  kindly 
shown  the  writer  another  form  of  functional  or  hysterical 
disorder,  which  was,  or  is  even  yet,  considered  by  many  gen- 
eral practitioners  a  scrofulous  enlargement  of  the  joints;  but 


WHAT   IS   MIND   CURE?  59 

the  doctor  discovered  the  peculiarity  of  metastasis,  which 
means  a  sudden  or  complete  removal  of  a  disease  from  one 
part  to  another.  This  gave  the  disease  what  he  termed  a 
hysterical  or  functional  character.  It  would  be  the  swelling: 
of  the  elbow  of  one  arm  and  the  knee  of  the  opposite  side  at 
one  time;  and  in  the  course  of  a  few  weeks  or  months  these 
would  feel  and  appear  entirely  well,  while  the  disease  had 
located  itself  in  other  joints.  This  case  the  doctor  consid- 
ered could  be  only  reached  through  the  mind,  or  some  faith 
cure.  He  further  believed  that  many  of  these  enlarged  and 
swollen  joints  among  the  wealthier  classes  were  due  to  a 
nervous  trouble.  Indeed,  it  would  be  an  easy  matter  to  cite 
case  after  case,  from  my  own  experience,  or  quote  cases  from 
the  highest  medical  authorities,  illustrating  in  every  con- 
ceivable manner  how  the  mind,  the  imagination,  the  emo- 
tions, or  the  different  passions,  are  continually  causing  dis- 
ease and  suffering. 

It  must  naturally  follow  that  what  is  potent  to  induce 
diseases  will,  under  different  conditions,  be  a  means  of  curing 
them. 

A  serious  question  now  arises  with  reference  to  the  selec- 
tion of  cases  suitable  to  mind-cure  treatment.  Bigoted 
fanaticism  is  quite  incompetent,  so  are  the  great  majority  of 
spiritual  healers,  owing  to  their  absolute  ignorance  of  the 
scientific  aspects  of  disease.  The  first  prerequisite  for  intel- 
ligent and  proper  treatment  is  to  establish  the  precise  nature 
of  the  disease  under  consideration.  It  must  be  distinctly 
grouped  or  classed,  whether  it  be  a  functional  or  hysterical 
disease,  or  a  zymotic  or  contagious  affection. 

In  diphtheria  or  typhoid  fever  mind  cure  subserves  no 
purpose;  the  treatment  must  be  avowedly  antiseptic  and 
stimulating. 

If  it  be  a  physical  injury,  say  a  fractured  bone,  it  must 
be  treated  on  mechanical  principles. 

A  woman  suffering  in  the  pangs  of  labor,  which  is  being 
delayed  from  some  abnormal  position  or  some  other  physi- 


60  HOME    TREATMENT. 

cal  obstruction,  can  only  be  delivered  through  mechanical 
methods;  and  here  the  enthusiastic  mind  healer  may  com- 
mit serious  errors,  sacrificing  limb  and  life  by  unnecessary 
delay.  So  I  would  lay  down  this  broad  maxim,  that  the 
mind  healer  must  either  be  a  competent,  educated  physician, 
or  a  physician  should  be  a  competent  metaphysician. 

Note.— In  the  year  1887  Mrs.  A.  C.  Hurrell  was  a  healthy,  middle- 
aged  woman  and  the  mother  of  two  children.  When  the  youngest  was 
ten  months  old  she  contracted  a  severe  cold.  The  coughing  spells  "  took 
her  hreath,"  and  from  these  exaggerated  expiratory  paroxysms  she 
drifted  into  spasmodic  asthma,  at  least  that  was  the  diagnosis  of  promi- 
nent medical  men  of  Sacramento  and  of  this  city.  Change  of  climate 
was  advised  and  tried,  so  were  also  the  different  drugs  which  experience 
had  taught  to  be  useful,  even  operations  were  performed  on  her  nasal 
passages  by  enterprising  specialists,  but  all  to  no  purpose.  Morphine 
was  prescribed  by  the  first  medical  attendant,  and  when  her  suffering 
became  unbearable  she  had  to  fall  back  on  this  drug  for  relief.  In  May, 
1890, 1  was  consulted,  but  a  most  careful  examination  revealed  nothing 
which  I  could  assign  as  a  cause  and  upon  which  to  base  a  hopeful  treat- 
ment. 

In  October,  1891,  she  was  persuaded  to  take  treatment  from  a  lady 
who  claimed  to  cure  through  Christian  Science  (a  mind  healer).  The 
treatment  commenced  on  a  Thursday  afternoon.  The  lady  impressed 
on  her  that  the  morphine,  of  which  she  now  consumed,  hypodermically, 
the  enormous  quantity  of  ninety  grains  a  week,  was  injurious,  and  that 
if  she  made  up  her  mind  that  there  was  no  disease  the  asthma  would 
leave  her.  Friday  night  the  patient  was  in  great  agony,  both  from  the 
withdrawal  of  the  drug  and  the  asthmatic  attack,  and  this  double  pres- 
sure weakened  the  faith  of  both  patient  and  healer,  but  the  husband 
stood  firm  and  insisted  that  she  have  no  morphine.  The  struggle  for 
breath  and  the  narcotic  continued  until  four  o'clock  Sunday  morning, 
when  she  began  to  get  easier;  the  improvement  continued,  and  in  ten 
days  she  had  "  outgrown  "  both.  I  saw  her  two  months  later,  entirely 
recovered,  and  the  most  brilliant  specimen  of  the  efficiency  of  mind  cure 
that  one  could  wish  to  see. 


CHAPTER   IV. 

GENERAL  CAUSES  OF  UTERINE  AND  PELVIC  DIS- 
EASES OF  WOMEN. 

Why  are  womb  diseases  so  prevalent?  is  a  question 
which  we  are  not  infrequently  called  upon  to  answer.  At 
first  sight  this  would  strike  one  as  a  casual  or  commonplace 
remark,  but  a  moment's  reflection  makes  it  one  of  vital  inter- 
est, for  a  truthful  and  intelligent  reply  lays  bare  the  causes 
which  undermine  the  health,  strength  and  character  of  the 
mothers  of  our  citizens,  and  when  a  disease  of  this  sort  be- 
comes common,  it  threatens  the  morality,  health  and  life  of 
our  nation. 

The  causes  which  operate  in  producing  these  diseases  of 
the  female  differ  widely  in  their  origin ;  some  are  due  to  ordi- 
nary imprudence,  while  others  are  deeply  rooted  in  moral 
depravity  and  marital  abuses  and  for  this  reason  I  consider 
it  convenient  to  arrange  them  into  three  distinct  classes  or 
groups. 

The  first  class  is  characterized  by  comprising  those 
causes  which  are  for  the  most  part  accidental.  They  are 
peculiar  to  confinement  and  motherhood,  and  may  be  in  a 
great  degree  controlled  or  averted  by  the  skillful  and  compe- 
tent accoucheur.  They  have  principally  a  scientific  interest, 
and  do  not  fall  within  the  scope  of  the  non-professional 
reader. 

The  second  class  is  entirely  beyond  anyone's  control. 
The  causes  belonging  to  this  category  are  innate  to  the  hu- 
man organism;  they  induce  those  numerous  afflictions 
which  here  and  there  sprout  up  in  previously  healthy  per- 
sons, and  are,  in  all  probability,  due  to  some  specific  hered- 

161) 


62  HOME    TREATMENT. 

itary  taint.  They  are  to  be  attributed  to  the  natural  imper- 
fections of  humanity,  and  are  a  constant  reminder  that  the 
body  is  simply  the  transient  abode  of  the  soul,  or  spiritual 
man,  and  as  such  only  perfect  in  its  imperfections.  Like  the 
causes  of  the  first  class,  these,  too,  have  principally  a  scientific 
interest. 

The  third  class  of  causes  of  uterine  diseases  constitutes  a 
very  large  group,  and  has  a  popular  or  general  interest.  For 
this  reason  it  should  be  freely  discussed,  because  the  causes 
of  this  class  are  avoidable. 

They  are  entirely  within  the  control  of  the  average  sen- 
sible person,  and  for  that  reason  should  be  known  and  under- 
stood by  everyone.  These  causes  superinduce  inflammatory 
diseases,  which  are  not  confined  to  the  womb  alone  but  take 
in  the  entire  pelvic  appendages,  the  Fallopian  tubes  and  ova- 
ries. They  are  the  greatest  source  of  revenue  to  the  doctors, 
and  vary  in  symptoms  in  different  persons,  from  a  slight 
casual  reminder  of  something  wrong  to  harassing  pains  and 
physical  suffering;  and  that  these  all  are  brought  about 
through  ignorance,  wanton  carelessness,  or  sinful  disrespect  of 
nature's  or  God's  law,  is  the  characteristic  feature  of  the  causes 
under  investigation. 

Exercise  in  the  open  air  is  so  essential  in  strengthening 
the  nervous  and  muscular  systems  that  where  this  is  neg- 
lected it  predisposes  to  womb  disease.  I  consider  the  differ- 
ently-devised indoor  or  room  calisthenics  or  exercises  as 
totally  inadequate  and  no  substitute  whatever  for  healthful 
outdoor  movement,  and  for  the  following  reason:  that  while 
it  irritates  the  muscular  and  nerve  fibers,  it  lacks  the  stimu- 
lating and  tonic  influence  of  pure  oxygen-laden  air,  so  that 
the  blood  becomes  still  more  deteriorated  and  overloaded  by 
excessive  waste  material,  which  is  not  thrown  off.  If  a  per- 
son exercise  at  all  with  a  view  of  deriving  physical  benefits, 
let  it  always  be  in  the  open  air.  Like  walking,  riding,  rowing, 
to  which  bicycling  should  be  added  as  one  of  the  very  best  of 
outdoor  exercises,  the  mind  can  then  be  engaged  at  the  same 


GENERAL   CAUSES.  03 

time,  though  it  must  not  be  overstrained.  The  great  obstacle 
nowadays  arises  from  a  fashionable  and  morbid  desire  to  culti- 
vate an  appearance  of  delicacy;  if,  instead,  recreations  which 
required  muscular  exertions  were  more  fashionable,  the  re- 
sults in  developing  strong  and  hardy  women  would  be  aston- 
ishing. 

No  exercise  can  be  profitable  which  is  not  interesting  to 
the  person  who  practices  it. 

It  is  not  the  bodily  exertion  alone  which  can  profit  a  per- 
son, but  the  happy  associations,  the  abandonment  of  self 
thought,  the  mental  relaxation,  and  the  pleasure  which  ac- 
companies it.  With  one  or  two  companions  we  can  have  a 
jolly  time,  while  taking  a  swimming  bath  or  floundering  in 
the  surf,  but  alone  it  soon  becomes  tiresome.  If  we  take  a 
stroll  with  an  agreeable  companion,  we  can  walk  a  distance 
which,  when  undertaken  alone,  would  fatigue  and  tire 
us  completely  out,  while,  when  with  an  associate  or  friend, 
we  cover  the  same  distance  refreshed  and  invigorated,  be- 
cause the  mind  is  entertained  while  the  body  is  exer- 
cised. This  must  have  been  the  experience  of  everyone,  and 
if  it  teaches  anything  worth  remembering,  it  teaches  that 
monotonous  exercises  should  be  avoided  and  entertaining 
ones  sought  and  practiced.  Walks  over  hills  in  small,  friendly 
groups  is  one  of  the  best  modes  of  exercise  I  know  of.  And 
then  there  remain  the  many  outdoor  games.  The  perni- 
cious systems  of  training  which  are  observed  in  some  female 
seminaries  often  plant  the  seeds  for  future  disease.  All  the 
school  hours  are  employed  in  reading,  drawing,  music,  and 
other  brain  work,  while  the  evenings  are  devoted  to  prepar- 
ing lessons  for  the  following  day.  This  is  very  injurious, 
and  should  never  be  permitted. 

After  school  hours  the  mind  should  have  complete  respite 
from  study,  so  that  the  forces  can  recuperate  themselves  for 
the  next  day. 

Nervousness  or  neurasthenia  is  often  a  result  of  this  ex- 
cessive mental  application.     Where  the  mind  is  constantly 


64  HOME    TREATMENT. 

engaged  in  intellectual  pursuits,  the  result  often  is  a  too 
rapid  dvelopment  of  the  brain  and  nervous  system. 

When  the  thoughts  and  memory  of  girls  of  tender  age  are 
too  long  and  too  laboriously  engaged,  there  will  be  an 
abnormal  development  of  the  nervous  centers;  they  will 
grow  or  develop  beyond  the  muscular  or  physical  strength, 
and  a  morbid  impressibility,  great  feebleness  of  the  muscular 
system,  and  a  marked  tendency  to  disease  of  the  pelvic  or- 
gans, is  established.  Parents  may  refer  with  pride  to  the 
precocious  talents,  the  refined  and  cultivated  tastes,  of  their 
daughters,  as  qualities  to  be  admired  and  appreciated,  but 
without  a  physical  substratum  it  is  a  dreamy  delusion.  It 
would  be  much  better  for  the  children  if  their  parents  took 
more  pride  in  rotund  figures  and  robust  constitutions,  for  these 
would  ever  be  a  source  of  joy,  while  the  cultivated  talents, 
especially  at  the  expense  of  their  health,  will  not  only  be  of 
little  practical  value  to  them  in  after  years,  but  often  inca- 
pacitate them  for  wives  and  mothers,  by  making  them  rest- 
less, discontented,  and  physically  unfit  for  maternal  func- 
tions. 

There  is  entirely  too  much  scholastic  education  imparted 
to  our  girls,  and  not  enough  domestic  education.  I  be- 
lieve that  the  most  favored  should  not  have  too  much  of 
one  and  not  enough  of  the  other,  because  if  parents  do  not 
prepare  girls  for  household  duties  in  early  life,  they  run  des- 
perate chances  of  laying  the  foundation  for  a  failure  in  the 
remote  future. 

Children  must  be  constantly  reminded  that  they  are  in 
this  world  to  serve  a  useful  purpose,  and  that  co-equal  with 
every  accomplishment  is  a  utilitarian  training. 

We  take  a  pride  if  our  boys  trade  pockctknives,  espe- 
cially when  our  own  gets  the  better  one  of  the  two,  because 
we  appreciate  the  natural  business  trait.  He  will  be  no  less 
a  good  candidate  for  some  of  the  learned  professions,  and,  in- 
deed, it  has  come  to  this,  that  material  success  in  the  profes- 
sions depends  as  much  on  shrewd  business  tact  as  it  does 
upon  proficiency  in  professional  attainments. 


GENERAL   CAUSES.  65 

The  knowledge  or  even  wisdom  of  a  person  is  of  no  earthly- 
use  to  himself  or  the  world  if  he  or  she  do  not  possess  the 
faculty  of  letting  the  people  know  of  this  superior  wisdom; 
and  that  is  why  some  persons  often  become  more  celebrated 
and  even  renowned  than  others,  who  are  intellectually  their 
superiors,  because  the  former  possess  the  faculty  and  cunning 
to  make  people  believe  in  their  superiority.  By  this  I  sim- 
ply desire  to  impress  upon  parents  not  to  be  overanxious 
about  their  daughters  standing  first  in  their  class  room,  but, 
rather,  to  be  very  anxious  that  they  attain  a  healthy  and 
vigorous  growth,  and  that  sufficient  practical  knowledge  of 
domestic  affairs  be  imparted  to  them  so  that  they  can  cred- 
itably fill  their  mother's  places  some  day.  This  I  consider 
the  best  legacy. 

The  time  to  commence  to  train  mothers  is  from  the  mo- 
ment they  are  born.  The  minds  of  parents  should  be  dis- 
abused of  the  false  delicacy  about  this  aspect  of  a  girl,  and 
while  no  one  expects  daily  lectures  to  be  given  to  children 
or  young  girls  upon  the  responsibilities  which  await  them, 
such  information  should  not  be  studiously  avoided.  I  insist 
that  this  important  fact  should  not  be  lost  sight  of,  mother- 
hood is  the  ultimatum  of  feminine  existence. 

Mistaken  conceptions  of  woman's  education,  in  pinning 
girls  to  a  life  of  close  mental  application,  is  often  produc- 
tive of  uterine  disease,  by  lowering  the  tone  of  the  nervous 
system ;  while  others  who  are  ambitious  to  acquire  a  profes- 
sional education  in  later  life,  fall  by  the  wayside  as  hope- 
less invalids. 

I  do  not  disparage  her  capacity  to  study  with  equal 
proficiency  the  arts  and  sciences,  often  with  more  ardor  and 
closer  application,  than  her  male  colleagues,  but  she  is  sim- 
ply striving  to  accomplish  that  which  the  men  can  and  do 
willingly  accomplish  for  her,  while  at  the  same  time  she 
is  neglecting  the  education  of  those  qualities  which  are  the 
sole  inheritance  of  her  sex,  and  which  man  could  not  usurp 
if  he  would. 
5 


66  HOME    TREATMENT. 

This  class  of  uterine  diseases  develops  in  a  few  years  into 
melancholy,  which  closes  the  windows  of  the  soul  to  the  sun- 
light  of  hope,  and  gradually  drags  the  sufferer  into  a  decline, 
that  nothing  but  an  entire  change  in  the  habits  and  thoughts 
of  the  patient  will  ameliorate  or  cure. 

I  would  have  our  girls  as  independent  of  our  boys  as  the 
latter  are  of  our  girls.  I  would  have  it  understood  that  each, 
in  their  specialty  for  which  God  and  nature  has  ordained 
them,  is  as  honorable  and  important  in  the  social  and 
industrial  conditions  of  mankind  as  the  other.  I  would  give 
woman  the  right,  and  deem  it  her  privilege,  to  frankly 
and  unrestrainedly  profess  her  fondness  or  desire  to  marry 
the  man  who  she  believes  would  make  her  a  desirable  hus- 
band, because  woman's  intuition  transcends  man's  reason. 

A  reform  in  this  direction  would,  indeed,  elevate  the 
woman  to  man's  estate,  where  she  belongs.  A  little  less  senti- 
ment and  more  sense  is  a  wholesome  panacea  for  some  of  the 
abuses  of  the  marital  contract. 

I  fully  subscribe  to  the  view  that  a  woman  shall  at  all 
times  receive  the  same  wages  for  her  mental  and  physi- 
cal labor  that  men  receive  for  the  same  work,  but  I  am 
entirely  opposed  to  that  modern  tendency  and  false  social 
philosophy  which  is  constantly  striving  to  make  a  man  out 
of  a  woman.  There  is  something  so  grossly  absurd  and  un- 
natural in  this  artificial  readjustment  of  the  natural  duties 
of  the  sexes,  in  their  industrial  and  social  relations,  that  it 
has  degenerated  in  many  instances  into  fanaticism. 

Women  are  organizing  everywhere  for  the  purpose  of  in- 
creasing the  facilities  of  their  sisters  in  the  studies  of  science 
and  philosophy.  Large  sums  are  offered  to  the  faculties  of 
universities  to  gain  admission  to  female  students  on  an 
equal  footing  with  the  male  students,  for  the  purpose  of 
studying  some  of  the  already  overcrowded  professions. 
In  the  main,  all  this  abnormal  rivalry  does  not  contribute  a 
single  advantage  to  either  sex. 

There  was  a  time  in  the  history  of  civilized  nations, 


GENERAL   CAUSES  07 

and  that  time  is  not  more  than  twenty  or  twenty-five  years 
.ago,  when  an  academical  education  gave  an  immense  ad- 
vantage to  its  possessor  over  his  less-informed  contemporary, 
but  this  is  not  true  in  our  time,  because  there  is  now  an  over- 
production of  college-bred  men.  The  man  who  can  decline  a 
Oreek  noun  or  conjugate  a  Latin  verb  is  no  longer  a  rarity, 
because  the  sons  of  European  tradesmen  and  American  farm- 
ers have  deserted  the  pursuits  of  their  progenitors — which,  in 
the  case  of  the  American  farmers,  is  to  be  deplored — and  ob- 
tained a  collegiate  education,  that  is  no  longer  the  inheritance 
of  the  privileged  few,  so  that  in  our  time  and  day  an  academi- 
cal education  has  run  to  seed  among  the  men.  And  now  the 
-attempt  is  being  made,  under  the  guise  of  social  progress,  to 
burden  our  girls  with  the  same  wisdom  that  has  incapacitated 
many  of  our  boys  from  making  an  honest  and  independent 
living.  It  would  be  much  better  for  the  State  if  two-thirds  of 
•our  universities  or  high  schools  were  changed  into  manual 
training  schools  or  polytechnical  colleges,  where  the  founda- 
tions for  the  industrial  pursuits  may  be  laid,  so  that  labor  will 
be  made  not  only  respectable  but  intelligent. 

We  wrould  then  hear  of  educated  mechanics  or  artisans, 
and  scientific  farmers,  which,  to  my  mind,  requires  the  same 
order  of  intelligence  to  excel,  that  it  does  in  the  professions 
generally  qualified  as  "learned." 

Why  crowd  our  girls,  then,  into  the  professions  for  which 
they  are  not  only  unsuited  by  nature,  but  which  are  already 
demoralized  by  the  keen  competition  within  their  ranks?  It 
is,  certainly,  an  open  secret,  in  the  profession  to  which  I  have 
now  devoted  the  best  years  of  my  life,  that  the  methods  in 
vogue  to  get  business  have  descended  to  the  level  of  the 
■"confidence  trickster,"  and  that,  no  matter  what  ability  or 
merit  a  person  may  possess,  without  the  natural  instincts  and 
olements  of  the  quack  and  charlatan  he  can  gain  neither  a 
livelihood  nor  fame.  This  theatrical  demeanor  of  the  pro- 
fession, this  aping  the  gaudy  display  of  European  aristocrats 
by  riding  in  closed  coaches,  driven  by  liveried  coachmen,  is 


68  HOME   TREATMENT. 

but  the  outward  symptom  of  the  internal  disease  of  conten- 
tion for  notoriety  and  success. 

If,  instead  of  all  this  false  and  demoralizing  philosophy,, 
termed  "woman's  rights" — which  is  more  appropriately 
designated  "woman's  wrongs" — we  turn  the  thoughts  and 
ambitions  of  women  towards  domestic  economy  and  domes- 
tic virtue,  which  alone  should  be  and  ever  will  be  the  ideal 
of  noble  womanhood,  there  will  be,  then,  much  less  disease, 
more  happiness,  and  less  discontent.  There  is  enough  on 
God's  earth  for  all  of  his  children  to  eat,  wrear,  and  work,  if 
the  labor  and  the  subsistence  are  fairly  and  wisely  appor- 
tioned. 

The  growing  sentiment,  which  is  as  vicious  as  it  is  ab- 
surd, is  that  a  girl,  to  be  educated  or  accomplished,  must  be 
either  a  teacher,  lawyer,  or  doctor,  or  anything  else  except  an 
accomplished  housekeeper,  just  as  though  it  required  less  tal- 
ent or  ability  to  raise  a  child,  cook  a  wholesome  or  digestible 
meal,  and  cut  or  sew  a  garment. 

Why,  there  is  much  more  thought  and  judgment  re- 
quired in  making  an  angel  mother  than  in  administering  or 
prescribing  a  dose  of  medicine  and  filing  a  legal  brief,  and 
there  is  not  a  lawyer  or  doctor  who  has  given  sufficient 
thought  to  the  duties  and  requirements  of  maternity  who 
disputes  it  for  a  moment.  If  our  strong-minded  women 
would  preach  this  doctrine,  which  would  tend  to  make  house- 
hold duties  respectable,  they  would  be  benefactors  instead  of 
mischief  makers,  and  then  our  comely  girls  would  prefer  to 
cultivate  habits  of  domesticity,  which  should  and  would  be- 
come as  honorable  an  occupation  as  that  of  a  doctoress  or 
lawyeress. 

Improprieties  of  dress  are  to  be  found  in  excessive  or 
deficient  clothing,  in  an  improper  adjustment,  and  in  an 
inherent  defect  of  the  undergarments.  I  will  reserve  some 
of  my  views  on  these  questions,  for  the  chapter  that  is 
devoted  to  hygienic  measures.  In  the  main,  the  custom  or 
manner  of  dressing  women  in  Christian  countries  does  not 


GENERAL   CAUSES.  69 

deserve  that  sweeping  denunciation  that  some  radical  dress 
reformers  make.  I  would  not,  if  I  could,  change  the  very 
becoming  and  graceful  modern  female  dress,  for  it  possesses 
the  merit  of  displaying  the  beauties  of  the  figure  in  a  mod- 
estly delicate  manner,  and  it  hides  its  defects  from  the  vul- 
gar gaze. 

As  a  rule,  there  is  too  much  pressure  on  the  abdomen, 
from  the  weight  of  heavy  skirts  that  are  suspended  from  the 
hips,  and  not  sufficient  room  for  the  chest  to  expand,  so  as 
to  accommodate  the  respirating  movements  of  the  lungs.  In 
the  absence  of  shoulder  bands,  to  which  the  skirts  should  all 
be  fastened,  the  much-decried  corset  has  its  redeeming  qual- 
ities, for  it  serves  the  purpose  of  a  yoke  or  support  for  the 
different  undergarments,  and  when  not  tightly  laced  is 
rather  a  benefit  than  an  injury,  and  if  the  corset  had  a  shoul- 
der strap  fastened  to  it  over  both  shoulders  so  as  to  keep  the 
garments  from  dragging  on  the  hips,  there  could  then  be  no 
objection  to  it  whatever.  The  corset  must  always  be  so 
loosely  worn  as  to  permit  the  wearer's  hands  to  be  easily 
passed  between  it  and  the  waist.  It  then  becomes  a  useful 
brace  to  a  weakly  woman  and  entirely  harmless  to  a  strong 
or  healthy  one.  We  can  imagine  how  a  tightly-fitting  corset 
will  cause  mischief  by  compressing  the  ribs  and  abdom- 
inal wralls,  and  that  this  absurd  fettering  will  prevent  the 
lateral  expansion  of  the  chest,  and  also  injuriously  press  upon 
the  internal  organs,  but  this  is  not  due  to  an  inherent  prop- 
erty of  the  corset  itself,  but  to  an  abuse  of  it.  One  might  as 
well  advocate  a  return  to  the  Roman  sandal,  on  the  ground 
that  some  persons  are  foolish  and  vain  enough  to  wear  shoes 
altogether  too  small  for  their  feet,  thereby  causing  deformi- 
ties and  corns.  For  my  part,  I  admire  a  nice,  well-shaped, 
healthy  foot,  incased  in  a  low,  broad-heeled,  comfortable  shoe, 
oven  if  its  size  were  one  or  two  numbers  larger  than  a  pinched- 
up,  deformed  one.  But  no  one  would  be  enthusiastic  enough 
on  the  question  of  healthy  feet  to  have  us  all  wear  sandals 
again. 


70  HOME    TREATMENT. 

Warmth  of  the  lower  extremities  is  a  very  important 
point  in  a  female's  apparel,  and  of  more  importance  than  all 
the  other  questions  raised  on  this  subject.  The  exposures 
endured  by  women,  from  ignorance  or  indifference  to  this 
fact,  is,  in  my  experience,  a  fruitful  source  of  disease.  The 
chilling  blast  which  sweeps  under  the  skirts  must  be  miti- 
gated and  the  moist  vapor  arising  from  a  damp  and  cold 
earth  neutralized.  If  the  limbs  are  only  protected  by  thin 
cotton  fabrics,  they  are  insufficiently  clad  to  avoid  the  evils 
above  mentioned.  It  is  of  the  greatest  importance  that  the 
limbs  of  women  should  be  incased  in  flannel  drawers,  and 
these  can  be  worn  underneath  the  white  muslin  or  linen  ones,, 
and  the  hose,  especially  in  cold  or  damp  weather,  should  be 
made  of  woolen  material;  the  soles  of  the  shoes  should  be 
sufficiently  heavy  so  as  not  to  be  permeable  by  the  moisture 
from  the  ground,  and  in  wet  or  rainy  weather  rubber  over- 
shoes are  always  a  necessity.  When  the  feet  and  lower 
limbs  are  kept  warm,  the  whole  body  is  more  or  less  protected 
against  cold. 

Superfluous  or  too  warm  garments  are  the  cause  of  an 
endless  variety  of  diseases.  The  rule  is  this,  that  any  gar- 
ment which  by  its  weight  or  thickness  excites  perspiration 
when  the  wearer  sits  quietly  or  exercises  moderately,  is  either 
superfluous  or  too  thick  or  heavy,  and,  as  perspiration  re- 
laxes and  softens  the  skin,  it  makes  one  susceptible  to  take 
cold.  It  is  reported  on  good  authority  that  sealskin  wraps 
cause  more  deaths  among  those  who  wear  them  than  typhoid 
fever  and  for  the  reason  above  mentioned.  Loosely-woven 
woolen  goods  make  the  best  wraps  and  the  best  underwear. 
If  we  were  called  upon  to  state  a  single  proposition  which 
we  considered  of  the  greatest  importance  in  preventing  dis- 
ease, we  would  frankly  say  that,  next  to  an  irregular  and 
unwholesome  diet,  excessive  clothing  is  the  most  mischiev- 
ous factor  in  causing  or  predisposing  to  disease. 

The  same  rule  applies  to  bedcovering;  if  it  be  so  heavy 
as  to  make  the  sleeper  sweat   during  the  night,  he  is  al- 


GENERAL   CAUSES.  71 

most  sure  to  take  cold  from  the  sudden  change,  from  a 
warm,  moist  bed  to  the  cool  room  or  comparatively  chilled 
clothing. 

Imprudence  during  menstruation.  A  heedless  disregard, 
ignorance,  or  carelessness  of  the  precautions  above  referred  to 
is,  during  the  catamenial  days,  quite  sure  to  lay  the  founda- 
tion for  disease.  Every  practitioner  has  met  with  a  great 
number  of  cases  where  the  disease  originated  during  men- 
struation from  some  indiscretion,  and  it  ran  on  for  years, 
until  a  condition  of  affairs  was  developed  which  was  well- 
nigh  incurable. 

The  female  organism  is  particularly  sensitive  about  this 
time  and  much  easier  affected  than  at  any  other. 

During  this  period  the  ovaries  and  uterus  are  intensely 
congested,  and  the  Fallopian  tubes  which  connect  the  former 
with  the  latter  share  this  condition,  and  if  a  cold  should  sud- 
denly check  or  interfere  with  the  natural  functions  of  these 
organs,  it  might  result  in  inflammation  of  the  ovaries  or  in  a 
catarrh  of  the  tubes  and  womb.  Any  one  of  these  conditions 
is  painful  and  often  troublesome  to  cure,  but  when  all  these 
organs  are  complicated  in  the  diseased  process,  which  we 
frequently  find  to  be  the  case,  it  may  entail  serious  conse- 
quences. 

Dysmenorrhea,  or  painful  menstruation,  will  be  a  promi- 
nent symptom,  if  any  of  the  above  organs  have  suffered  from 
imprudence,  during  this  period,  and  I  have  known  of  cases 
which  gave  me  no  end  of  trouble  before  they  were  restored 
to  health. 

Measurements  of  the  healthy  uterus.  In  a  grown  person 
the  average  length  is  three  inches,  two  inches  in  breadth  and 
an  inch  in  thickness.  It  weighs  from  an  ounce  to  an  ounce 
and  a  half.  The  size  of  the  uterus  is  an  important  guide  to 
the  physician  in  establishing  the  presence  or  absence  of  cer- 
tain diseases. 

In  the  child-bearing  period  measurements  and  weight 
change,  because  the  organ  grows  correspondingly  large  to. 
accommodate  the  growth  of  the  child. 


72  HOME    TREATMENT. 

Growth  of  the  uterus  from  the  moment  of  conception  is 
one  of  the  most  interesting  physiological  studies.  All  its 
tissues,  muscles,  nerves,  vessels,  and  lymphatics  are  increased 
in  bulk  and  multiplied  in  number.  The  human  ovum  is 
an  extremely  minute  microscopic  cell,  from  one  two-hundred- 
and-fortieth  to  one  one-hundred-and-twentieth  of  an  inch  in 
diameter.  This  grows  so  rapidly  that  at  the  end  of  nine 
months  we  often  have  the  average  nine-pound  baby.  The 
growth  of  the  muscular  fibers  of  the  womb  is  truly  remark- 
able. They  grow  eleven  times  longer  and  twice  to  four  times 
thicker,  so  that  the  growth  of  the  womb  keeps  pace  with 
that  of  the  child. 

Changes  immediately  after  confinement.  Women  as  a 
rule,  and  their  husbands  also,  are  wofully  ignorant  of  the  con- 
dition of  the  womb  just  after  confinement,  and  at  this  point 
it  will  be  opportune  to  impart  the  necessary  information  illus- 
trating that  it  is  one  of  the  most  critical  periods  of  the  entire 
process,  because  the  pelvic  organs  are  again  very  sensitive, 
somewhat  akin  to  the  menstrual  condition,  namely,  one  of 
engorgement,  or  congestion. 

After  the  child  is  in  the  world,  the  uterus  usually  con- 
tracts to  about  the  size  of  a  cocoanut;  its  measurements  and 
weight  as  compared  with  what  it  was  before  pregnancy  have 
materially  increased. 

The  diameter  is  now  about  four  inches,  and  its  weight  a 
little  over  two  pounds.  If  we  now  stop  to  reflect  that  its 
weight  was  formerly  an  ounce  to  an  ounce  and  a  half,  to 
which  size  and  weight  it  must  again  return,  we  can  readily 
appreciate  the  important  changes  that  must  take  place  to  ac- 
complish this  object.  The  scientific  world  has  only  learned 
how  this  is  effected  within  the  last  thirty  years.  It  was  a 
very  important  discovery.  The  superfluous  or  excessive  tis- 
sues are  converted  into  fat — the  process  is  called  fatty  degener- 
ation— and  as  fat  the  tissues  are  absorbed  into  the  blood  and 
disposed  of,  and  thus  gradually  is  the  superabundant  sub- 
stance removed,  until  its  measurements  are  as  they  were  for- 
merly and  its  weight  as  it  was  before. 


GENERAL   CAUSES.  73 

Involution  is  the  name  given  to  this  process  by  medical 
writers.  It  signifies  a  rolling  back  of  the  size  and  substance 
of  the  womb  to  where  it  was  before  pregnancy.  It  is  the 
physiological  activity  in  the  tissues  of  the  organ  to  restore  it 
to  its  former  size  and  healthfulness.  The  time  usually  re- 
quired for  nature  to  accomplish  this  remodeling  varies  in 
different  individuals  from  six  weeks  to  three  months. 

Sub-involution  is  a  term  employed  to  designate  a  partial 
or  complete  cessation  of  this  restorative  action.  The  prefix 
mb  means  always  under;  in  this  case  the  same  thing  is  meant, 
under-involution  or  incomplete  involution. 

When,  in  six  weeks  to  three  months  after  confinement, 
the  womb  has  not  returned  to  its  previous  healthy  size, 
weight  and  state,  or  if  the  enlargement  of  the  womb  incident 
to  pregnancy  lasts  longer  than  already  specified,  we  have  the 
disease  termed  sub-involution.  It  generally  becomes  com- 
plicated with  inflammation  of  either  the  cavity  of  the  womb  or 
of  its  entire  substance,  and  often  the  inflammation  extends 
to  all  the  other  organs  and  tissues  in  the  pelvis. 

Indiscretion  in  getting  up  too  soon  may  cause  this  state 
of  affairs.  Taking  cold  and  excessive  exertion  should  be 
guarded  against. 

A  mother  who  has  just  been  delivered  must  gradually 
feel  her  way  as  to  how  much  and  what  she  may  or  can  do 
without  jeopardizing  her  recovery.  Pains  in  the  pelvis,  back, 
and  thighs,  or  a  heavy,  dragging  sensation  after  getting  up, 
indicate  a  sub-involution.  These  symptoms  should  be  at- 
tended to,  because  the  longer  they  last  the  more  obstinate 
the  disease  becomes. 

Lying  on  the  back  after  confinement  for  ten  or  twelve 
days  is  not  only  injurious  but  an  unnecessary  hardship  for 
every  mother.  It  is  one  of  the  most  fruitful  causes  of  an  ab- 
normal position  or  falling  back  of  the  womb,  and  very  often 
this  excites  diseases  which  greatly  complicate  the  improper 
location  of  the  organ. 


74  HOME   TREATMENT. 

Retroversion  and  retroflexion  of  the  womb  will  be  con- 
sidered more  minutely  later  on.  It  is  generally  caused  by 
this  common  error  of  nurses  and  physicians,  who  allow  the 
delivered  woman  to  lie  and  often  insist  on  her  lying  on  the 
back.  Thus  the  womb  gradually  sinks  backwards,  instead  of 
falling  forwards,  where  it  belongs:  see  Plate  IV. 

Women  will  not  generally  feel  that  anything  is  wrong 
until  some  time  after  they  are  up  and  around.  The  first  few 
weeks  or  months  after  confinement,  persons  are  inclined  to 
attribute  their  weakness,  pains  in  the  back  or  thighs,  and 
other  disagreeable  sensations,  to  the  natural  consequences  of 
what  they  have  gone  through.  But  after  weeks  roll  into 
months,  and  their  former  strength  and  health  do  not  return, 
then  they  seek  the  advice  of  a  doctor,  who  will  disclose  to 
them  the  cause  of  their  suffering.  This  can  be  avoided 
every  time  by  changing  the  positions  of  lying,  from  one  side 
to  the  other,  and  from  the  back  to  the  stomach  for  a  change ; 
then  naturally  the  womb  will  gradually  resume  its  normal 
position,  which  is  inclined  forward  and  rests  with  its  body 
over  and  on  the  bladder.  All  of  these  displacements  should 
receive  early  and  prompt  attention. 

Antiseptic  precautions.  Only  a  few  years  ago  this  phrase 
was  entirely  unknown.  It  originated  with  the  modern  anti- 
septic treatment  of  wounds,  and  from  the  domain  of  surgery 
it  has  been  transplanted  into  the  department  of  obstetrics,  in 
which  the  application  of  antiseptic  principles  has  achieved 
the  most  brilliant  triumphs.  From  this  conception  has 
sprung  the  germ  theory  of  disease,  which  is  now,  beyond 
doubt,  an  established  fact. 

I  never  can  forget  my  first  case  of  childbed  fever.  It  is 
only  fourteen  years  ago,  and  then  there  was  as  yet  no  one 
who  could  give  a  scientifically  truthful  interpretation  of  the 
disease.  My  patient  was  a  young  mother,  who  was  being 
rapidly  consumed  by  a  fever,  but  beyond  that  science  had 
not  unlocked  the  causes  lurking  in  the  organism,  which  had 
doomed  the  young  woman,  on  the  threshold  of  motherhood, 
to  a  premature  grave. 


GENERAL    CAUSES.  75 

Thousands  of  lives  were  yearly  destroyed  by  puerperal 
fever.  Volumes  of  literature  had  been  written  on  the  subject, 
but  as  yet  no  one  had  deciphered  its  origin. 

Now  the  whole  scene  has  shifted;  we  know  that  the  fever 
is  essentially  a  blood  poison,  a  septic  infection  of  the  patient, 
precisely  similar  to  a  wound  infection  anywhere  else  on  the 
body.  The  act  of  parturition  causes  wounds  or  abrasions; 
these,  then,  place  the  woman  in  imminent  danger  of  infec- 
tion of  every  sort,  and  it  is  this  infection  which  it  is  now 
possible  to  avoid.  There  is  the  greatest  precaution  necessary 
on  her  part  and  on  the  part  of  her  attendants,  that  she  be 
not  contaminated  by  suspicious-looking  finger  nails,  or  dirty 
hands,  or  soiled  linen,  or  unhealthy  and  unclean  surround- 
ings. 

The  German  Government  has  a  compulsory  law  for  a 
system  of  antiseptic  precautions,  which  is  incumbent  upon 
all  who  attend  lying-in  women.  The  importance  of  a  rule 
to  guide  midwives  and  others  in  carrying  out  strictly  anti- 
septic measures  was  recognized  in  that  country  some  ten 
years  ago,  and  the  statistics  show  a  remarkable  diminution 
of  diseases  peculiar  to  the  childbed  period.  The  sources  of 
these  infectious  micro-organisms  are  very  different.  They 
may  be  derived  from  the  body  of  another  person,  sick  or 
having  died  from  an  infectious  disease,  from  suppurating 
wounds  and  even  from  the  secretions  of  healthy  lying-in 
patients.  The  patient  or  person  herself  may  have  improp- 
erly bathed  or  neglected  cleanliness  and  ablutions,  but  the 
greatest  danger  arises  from  the  neglected  and  unclean  hands 
and  sleeves  of  the  midwives  and  physicians,  and  from  the 
instruments  usually  employed  under  these  circumstances, 
like  forceps,  catheters,  or  the  nozzle  of  a  syringe.  The  law 
above  referred  to  requires  all  these  instruments  to  be  thor- 
oughly scalded,  washed,  and  brushed  every  time  they  have 
been  used,  and  by  such  a  complete  system  of  disinfection, 
the  chances  of  infection  are  reduced  to  the  minimum.  I 
hope  some  day  our  legislators  will  be  wise  enough  to  give  us 
similar  laws. 


CHAPTER  V. 

UNCLEANLINESS  AS  A  CAUSE  OF  DISEASES  IN 
WOMEN. 

The  custom  of  washing  and  bathing  has  existed  from 
the  earliest  times.  Among  the  Egyptians  it  was  a  part  of 
their  religious  worship.  Among  the  Jews  it  formed  part  of 
the  ceremony  of  purification  prescribed  by  Moses.  The 
Greeks  considered  it  a  sanitary  expedient,  and  among  the 
Romans  it  was  instituted  for  similar  purposes.  All  virtues 
when  carried  to  extremes  degenerate  into  folly  or  vice,  so 
bathing  in  the  days  of  the  Roman  Empire,  became  immod- 
erate and  degenerated  into  enervating  luxury  and  un- 
bridled debauchery,  in  which  indiscriminate  bathing  of 
both  sexes  was  one  of  the  demoralizing  features. 

The  bath  was  usually  taken  after  exercise  and  before 
the  principal  meal,  which  rule  holds  good  to-day,  as  the 
very  best  and  proper  time.  The  gorgeous  splendor  of  the 
Jhermae,  which  was  a  palatial  edifice  constructed  by  Agrippa, 
was  adorned  with  beautiful  statues  and  fine  paintings, 
while  luxuriant  green  foliage  of  great  variety  formed  en- 
chanting bowers  of  fairy  splendor.  This  was  thronged  by 
the  Roman  citizens  for  the  pleasures  of  gymnastic  exercises 
and  bathing. 

In  those  countries  which  have  adopted  the  religion  of 
the  Arabian  prophet,  Mohammed,  people  bathe  as  a  part  of 
their  devotions,  and  a  religion  which  has  for  a  part  of  its 
ritual  the  washing  of  the  body,  goes  a  great  way  towards 
cleansing  the  spirit. 

Among  the  Northern  nations  the  introduction  of  the 
bath  dates  back  to  the  period  of  the  Crusaders,  although 
(76) 


UNCLEANLINESS  A   CAUSE   OF   DISEASE.  77 

Tacitus  speaks  of  the  river  bathing  of  the  Germans,  which 
was  one  of  the  strengthening  methods  employed  by  the 
early  Saxons.  That  filth  and  dirt  generate  crime  and 
moral  depravity  seems  to  be  apparent,  where  squalid  misery 
has  dulled  the  sensitiveness  to  unwholesome  surroundings. 

Sanitary  science  has  also  demonstrated  that  filth  is  the 
most  fruitful  source  of  diseases  that  are  called  infectious, 
because  their  origin  is  due  to  germs  of  the  lowest  forms  of 
vegetable  life.  The  brightest  page  in  the  medical  history 
of  the  nineteenth  century  is  that  which  records  the  dis- 
covery of  these  micro-organisms  as  the  cause  of  such  dis- 
eases as  septicaemia  or  blood  poisoning,  pyaemia,  diphtheria, 
tuberculosis  or  consumption  and  others.  All  forms  of  fer- 
mentation and  putrefaction  are  due  to  the  presence  of  some 
germs,  and  upon  this  fact  antiseptic  surgery  bases  its  scien- 
tific premises. 

The  germ  theory  of  disease,  like  every  new  discovery, 
which  supplants  the  accustomed  and  deeply-rooted  theo- 
ries of  the  speculative  philosophers,  met  with  opposition, 
criticism,  ridicule  and  misconstruction,  but  the  brilliant 
achievements  of  Lister  and  Koch  have  established  its  found- 
ers upon  a  pinnacle  of  fame,  which  promises  to  be  an  im- 
mortal monument  to  their  genius,  and  not  only  in  surgery 
has  its  beneficial  influence  been  exerted,  but  the  entire  field 
of  medicine  has  been  enriched  by  the  germ  theory,  which 
plays  so  formidable  a  part  in  the  causation  of  many  diseases. 

The  great  boon  that  medical  science  will  confer  upon 
humanity,  in  the  future,  will  not  be  so  much  in  improved 
methods  of  treatment,  as  in  the  means  and  methods  which 
medical  science  will  devise  for  preventing  disease.  One 
ounce  of  prevention  will  always  be  worth  a  pound  of  cure. 
When  we  look  back  fifteen  or  twenty  years,  we  must  even 
now  acknowledge  that  preventive  medicine  has  accom- 
plished greater  results  than  curative  measures,  because  the 
former  can  be  made  in  the  very  nature  of  things  absolute, 
while  curative  agents  are  only  relative.     Puerperal,  or  child- 


78  HOME   TREATMENT. 

bed  fever,  which  is  an  infectious  disease,  was  at  times  a  pesti- 
lence, which  destroyed  women  by  the  score,  in  maternity 
hospitals,  or  in  certain  neighborhoods,  by  the  infection  be- 
ing carried  by  midwives  or  accoucheurs  from  house  to 
house,  yet  no  one  had  the  least  suspicion  that  it  was  pos- 
sible to  carry  the  germs  of  this  disease  under  the  finger- 
nails of  the  attendant,  or  on  the  clothing  or  a  syringe,  or  on 
some  other  little  instrument,  from  one  patient  to  another,  and, 
indeed,  there  are  a  great  many  to-day  who  are  practicing  mid- 
wifery who  are  still  ignorant  of  the  importance  of  refined 
cleanliness. 

But  for  this  ignorance,  there  is  no  longer  an  excuse,  be- 
cause the  infectiousness  of  this  and  other  diseases  is  so  pos- 
itively established,  and  even  the  physical  characteristics  of 
the  micro-organisms  have  become  familiar  to  the  micros- 
copists.  This  knowledge  of  the  causation  of  puerperal 
fever  has  been  applied  to  the  employment  of  preventive 
measures,  so  that  this  dreadful  malady  is  becoming  a  rarity, 
particularly  in  countries  where  scrupulous  care  and  cleanli- 
ness are  enforced  by  governmental  rules  and  regulations. 
I  refer  to  this  particular  fever,  because  it  is,  to  my  mind,  one 
of  the  most  brilliant  illustrations  of  the  efficacy  of  preventive 
or  antiseptic  medicine. 

There  is  a  gynecological  hygiene  with  which  women 
should  become  familiar ;  it  is  based  on  the  principle  of  anti- 
septic precautions  applied  to  the  daily  lives  of  their  sex. 
The  object  of  this  is  to  keep  the  body  and  reproductive  or- 
gans that  are  exposed  to  contamination  or  infection  from 
the  outer  world  in  the  most  refined  and  scrupulous  cleanli- 
ness. The  vaginal  douche  or  syringe  is  as  important  an 
auxiliary  to  a  refined  woman's  toilet  case  as  her  tooth 
brush,  because  the  cleanliness  of  the  genitals  is  as  essential 
to  the  preservation  of  health  and  comfort,  as  the  possession 
of  a  sweet  breath  and  the  preservation  of  the  teeth.  I  am 
therefore  convinced  of  the  hygienic  value  of  familiariz- 
ing little  children  with  washing  or  sponging  their  external 


UNCLE  ANLINESS  A   CAUSE   OF   DISEASE.  79 

genitals;  in  a  few  years  this  will  have  become  second  nature, 
and  they  are  thus  protected  for  all  future  time  from  con- 
tracting diseases  which  have  their  origin  in  personal  un- 
cleanness.  It  behooves  mothers  to  avoid  all  delicacy  on 
this  subject,  so  that  their  little  ones  may  grow  up  with  the 
sentiment  that  to  the  pure  in  heart  all  things  are  pure. 
It  is  false  modesty  and  ignorance  which  degenerate  into 
vice  and  excesses;  the  scientific  truth  is  always  pure  and 
holy,  because  it  is  based  on  reason,  while  abnormal  delicacy 
is  only  emotional,  and  is  quite  likely  to  shoot  into  the  other 
extreme,  namely,  licentiousness. 

As  the  world  grows  wiser,  the  physiology  of  the  reproduc- 
tive organs  should  form  a  part  of  its  wisdom,  and  in  pro- 
portion to  this  knowledge,  will  their  functions  become  ques- 
tions of  sense,  instead  of  sentiment  and  nonsense. 

The  vagina  is  a  membranous  canal.  It  is  situated  in  the 
cavity  of  the  pelvis,  below  and  behind  the  bladder,  and  in 
front  and  above  the  rectum.  Its  direction  is  curved  from 
before  backwards  and  a  little  upwards;  its  walls  are  flattened 
and  ordinarily  in  contact  with  each  other.  Its  length  is 
about  four  inches  along  its  anterior  wall,  and  an  inch  or  two 
longer  along  its  posterior  wall.  In  introducing  a  nozzle  of 
a  syringe  it  must  always  be  remembered,  that  the  tube  is  to 
be  introduced  directly  backward  on  a  horizontal  plane  with 
the  body  in  the  erect  posture;  by  attempting  to  introduce  it 
directly  upwards,  you  meet  with  resistance  from  the  anterior 
wall  of  the  vagina. 

In  this  cavity  the  secretion  is  susceptible  of  decomposi- 
tion, owing  to  the  accessibility  of  air  laden  with  germs, 
which  excite  fermentation.  A  day  or  two  after  the  cessation 
of  the  menstrual  flow,  there  still  lingers  a  little  blood  in  the 
cavity  of  the  vagina ;  this  becoming  infected  with  the  germs 
in  the  vagina,  a  decomposition  is  the  result,  which  is  recog- 
nized by  an  offensive  smell.  The  naturally  soothing  and 
harmless  secretion  is  now  changed  into  an  acrid,  irritating 
fluid,  which  not  only  may  cause  an  inflammation  of  the 


80  HOME    TREATMENT. 

membrane  of  the  vagina,  but  also  excoriate  the  skin  at  the 
orifice  of  the  canal. 

Leucorrhoea,  or  what  is  commonly  called  whites,  is  the 
most  distressing  symptom  of  this  condition.  In  the  course 
of  months  or  in  some  instances  a  few  years,  the  inflamma- 
tion spreads  from  the  vagina  to  the  mouth  and  lining  mem- 
brane of  the  uterus.  Inflammation  of  the  endometrium  or 
lining  of  the  womb  will  excite  another  complication,  the  so- 
called  ulceration,  but  more  correctly  termed  erosion.  Who 
will  deny  the  usefulness  of  any  advice  that  will  teach  girls 
or  women  to  avoid  all  these  diseases?  It  is  all  contained  in 
the  simple  phrase,  Keep  clean.  Young  girls  must  be  taught  by 
their  mothers  or  guardians,  not  only  the  necessity  of  keeping 
the  external  genitals  clean  by  daily  ablutions,  but  a  few 
days  after  menstruation,  upon  the  slightest  indication  of 
offensiveness,  she  must  resort  to  the  employment  of  the  vag- 
inal douche  or  syringe,  so  as  to  wash  out  the  seeds  of  dis- 
ease, that  are  rapidly  multiplying  themselves,  and  if  al- 
lowed to  remain  will  entail  the  consequences  to  which  I 
have  already  referred. 

As  an  antiseptic  wash,  there  is  nothing  so  simple,  effica- 
cious and  healing,  as  a  solution  of  borax  in  previously 
boiled  water,  that  has  been  allowed  to  cool  to  the  proper 
temperature,  which  is  between  103  and  10G  degrees  Fahr., 
one  teaspoonful  of  the  powdered  article  to  the  half  gallon 
of  water,  to  be  used  as  a  rinsing  for  each  time. 

Directions  for  administering  vaginal  douches  will  be 
given  elsewhere.  The  proper  time  of  the  day  for  the  em- 
ployment of  the  wash  is  always  at  bedtime;  and  once  or 
twice  a  week  is  quite  often  enough  in  the  majority  of  in- 
stances. 

Married  women  are  more  exposed  to  infectious  contam- 
ination than  single  ones,  because  they  are  constantly  liable 
to  have  infectious  microbes  introduced  into  the  vagina  dur- 
ing the  ordinary  course  of  marital  relations.  Men,  as  a 
rule,  are   neither   cleanly  nor  careful  in  their  habits,  and 


UNCLEANLINESS   A   CAUSE   OF   DISEASE.  81 

approach  their  wives  without  any  thought  of  serious  con- 
sequences in  their  sexual  relations.  I  had  a  married 
woman  under  treatment  for  an  offensive  discharge  from 
her  vagina  which  I  traced  to  her  husband,  thence  to  a  sup- 
purating wound  on  his  horse,  which  the  husband  had  under 
his  treatment.  This  can  happen,  of  course,  only  through 
carelessness.  By  getting  some  of  the  matter  or  pus  on  the 
fingers,  which  incidentally  contaminates  his  person,  or  not 
washing  and  brushing  the  finger  nails,  the  husband  may 
directly  convey  the  infection  to  his  wife,  and  thus  inaugurate, 
unconsciously,  an  inflammation  of  the  vagina,  which  becomes 
complicated,  as  the  primary  disease  is  neglected,  leading  to 
inflammation  of  the  womb  and  ovaries,  and  often  to  ab- 
scesses, that  compromise  not  only  the  health  but  the  life  of 
the  sufferer. 

To  preclude  the  possibility  of  innocent  infection,  between 
husband  and  wife,  there  is  only  one  means  of  prevention, 
and  that  is  a  careful  toilet,  which  thoroughly  cleanses  the 
bodies  in  general  and  the  genitals  in  particular. 

Another  fruitful  source  of  disease  of  women,  in  this  coun- 
try and  to  an  alarming  extent  in  Europe,  to  which  the  elder 
Martin  of  Berlin  called  the  attention  of  the  profession  over 
thirty  years  ago,  is  the  specific  or  gonorrheal  infection  of 
wives  by  their  unfaithful  husbands.  The  number  of  poor 
women  whose  health  has  been  irretrievably  ruined,  by  their 
husbands  having  had  illicit  relations  with  lewd,  diseased 
women,  is  only  known  to  those  who  have  made  this  class  of 
diseases  a  special  object  of  inquiry.  I  have  nothing  to  do  with 
the  moral  aspect  of  this  question,  but  only  with  the  physical 
suffering  that  such  men  inflict  upon  their  innocent  wives 
and  the  mothers  of  their  children,  for  the  brief  indulgence 
of  libidinous  pleasure.  To  think  that  any  man  would  take 
the  chances  of  making  his  wife  a  suffering  and  perhaps  in- 
curable invalid,  just  for  the  purpose  of  gratifying  temporary 
animal  passions,  is  to  place  him  beneath  the  brute  creation, 
which  has  not  the  intelligence  to  reason  on  the  fearful  con- 
6 


82  HOME    TREATMENT. 

sequences.  No  man  who  has  been  guilty  of  illicit  relations 
should  return  to  his  wife  until  seven  days  have  elapsed,  and 
even  not  then  until  he  has  repeatedly  washed  himself  by 
means  of  a  syringe  with  some  cleansing  or  disinfecting  fluid, 
like  borax  water,  or,  what  is  preferable,  a  weak  solution  of 
the  bichloride  of  mercury. 

The  wife  and  mother  who  entertains  the  slightest  sus- 
picion, must  insist  upon  these  precautions,  and  then  not 
neglect  to  thoroughly  wash  and  cleanse  herself  in  the  man- 
ner previously  referred  to.  It  is  the  height  of  hypocrisy 
to  be  mealy  mouthed  on  this  subject;  the  wives  and  moth- 
ers who  are  fortunate  to  have  husbands  beyond  suspicion, 
should  learn  that  some  of  their  sisters  have  dangers  to  en- 
counter and  heartaches  to  suffer,  with  which  their  own  lives 
are  not  marred,  but  perhaps  the  lives  of  their  daughters  may 
be ;  for  the  unhappy  woman  who  becomes  the  wife  of  the 
blear-eyed  sensualist,  there  is  only  one  relief,  and  that  is  edu- 
cation in  these  subjects. 

I  know  of  no  disease  in  which  a  correct  and  early  diag- 
nosis or  recognition  is  of  greater  importance  to  avoid  the 
frightful  consequence  and  serious  complications,  than  this 
one.  It  begins  with  a  mild  vaginal  catarrh,  which,  when  it 
is  as  yet  locally  confined  to  the  vagina,  can  be  easily  cured. 
In  course  of  time  it  spreads  itself  along  the  vaginal  tract  to 
the  cavity  of  the  womb.  When  it  gets  there,  the  treat- 
ment becomes  more  complicated,  and  for  this  reason ;  in  or- 
der to  reach  the  disease  now,  the  cavity  of  the  womb  must 
be  dilated,  and  this  is  an  operation  which  the  average 
physician  can  only  accomplish  in  a  bungling  and  imperfect 
manner.  But  even  in  this  stage  of  the  disease,  in  the  hands 
of  a  skillful  physician,  the  course  of  the  disease  can  be 
checked  and  the  patient  readily  cured.  When  the  disease 
gets  beyond  the  womb,  when  it  invades  the  Fallopian  tubes 
and  the  ovaries,  the  picture  has  entirely  changed. 

The  organs  affected  are  then  inaccessible  to  local  treat- 
ment, so  that  the  disease  invariably  continues  until  the  or- 


UNCLEANLINESS   A   CAUSE   OF   DISEASE.  83 

gans  are  more  or  less  destroyed  by  inflammation,  which 
results  in  the  tissues  breaking  down  into  an  abscess.  In 
this  stage  of  the  disease  it  has  become  quite  the  fashion  to 
operate  in  this  class  of  cases,  offering  as  an  excuse  a  sure 
and  speedy  cure.  Here  I  would  interpose  a  word  of  warn- 
ing to  sufferers  belonging  to  this  class,  not  to  be  too  willing 
to  comply  with  surgical  methods,  because  I  know  from  care- 
ful observations,  that  promises  of  this  nature  end  often 
in  disappointment  and  death,  while  an  intelligent  conserv- 
ative treatment  can  only  disappoint  but  never  kill,  and  with 
patience  and  perseverance  in  the  application  of  electricity 
and  hygienic  rules  of  health,  a  cure  is  almost  certain.  The 
sick  in  body  and  mind  are  often  beguiled  into  operations  of 
a  very  serious  nature,  which  are  entirely  unnecessary,  be- 
cause better  results  can  be  accomplished  by  other  methods 
of  cure,  in  which  the  possibility  of  a  fatal  termination  is 
excluded. 

Some  women  feel  tired  and  languid  from  morning  until 
night.;  they  feel  as  tired  in  the  morning  when  they  get  up 
as  they  were  in  the  evening  when  they  retired.  If  we 
tell  them  that  it  is  entirely  due  to  negligence  of  their  own 
persons  in  not  using  vaginal  washings  regularly,  they  will 
undoubtedly  feel  surprised.  In  the  great  majority  of  these 
•cases,  this  is  owing  to  putrefactive  changes  going  on  in  the 
•cavity  of  the  vagina.  In  the  process  of  fermentative  decom- 
position, the  so-called  ptomaines  are  developed;  these  are 
■chemical  poisons,  which  are  absorbed  into  the  blood,  and 
by  their  depressing  influences  on  the  nervous  system  are 
the  cause  of  the  weakness  and  tired  feeling.  There  are  no 
remedies  which,  when  taken  into  the  stomach,  will  do  the 
slightest  good  for  this  condition,  and  it  is  a  waste  of  both 
time  and  money  to  expect  relief  from  drugs. 

This  can  easily  be  remedied  by  cleanliness,  so  that  the 
secretions  are  not  long  enough  retained  in  the  vagina,  to 
■decompose  and  develop  these  ptomaine  poisons. 

During  and  after  confinement  is  another  important  time 


84  HOME    TREATMENT. 

for  the  employment  of  vaginal  washes.  The  lochial  discharge,, 
which  is  one  of  the  ordinary  accompaniments  of  the  newly- 
delivered  woman,  is  a  discharge  from  the  uterus,  which  con- 
tinues for  several  days,  growing  less  and  less,  for  a  few 
weeks,  when,  in  a  normally  healthy  state  of  affairs,  it  should 
cease  entirely.  The  lochia  is  the  oozing  from  the  mouths 
of  the  blood-vessels  of  the  womb  where  the  placenta  or  after- 
birth was  attached,  together  with  the  passing  off  of  the  old 
lining  membrane  of  the  womb,  while  the  organ  is  returning 
to  its  original  condition.  At  first  the  discharge  is  bloody, 
and  it  may  retain  this  character  for  two  or  more  days  after 
delivery ;  then  the  color  is  changed,  partaking  more  or  less 
of  a  watery  nature  and  presenting  a  yellowish  hue;  it  then  be- 
comes whitish  and  ultimately  ceases  altogether.  After  the 
first  four  or  five  days  the  lochial  discharge  often  becomes  very 
offensive;  this  is  a  sign  of  putrescence  or  decomposition,  and 
the  only  remedy  in  this,  as  in  all  other  similar  instances,  is 
to  wash  the  vagina  thoroughly  with  borax  water,  or  with  a 
preparation  for  which  a  prescription  will  be  given  further 
on. 

In  every  case  of  delivery,  the  mouth  of  the  womb  is  more 
or  less  torn  or  lacerated;  this  is  unavoidable,  and  it  is  gener- 
ally harmless.  One  of  the  surgical  humbugs  is  to  sew  or  stitch,, 
or  attempt  to  stitch,  these  little  harmless  tears  together,  not 
of  course  for  the  good  it  will  do  the  patient,  because  she  is 
more  likely  to  be  injured  by  this  meddlesome  surgery,  but 
to  make  a  business  and  a  fee.  The  common  practice  of  these 
and  kindred  surgical  expedients  is  one  of  the  crying  evils  of 
an  overcrowded  profession  which  is  trying  to  keep  itself  em- 
ployed at  all  hazards. 

The  vagina  also  receives  more  or  less  injury  during  an 
ordinary  confinement;  if  the  midwife  or  the  doctor  is  too 
meddlesome  or  in  too  big  a  hurry  to  get  through,  he  will 
use  the  forceps,  which  simply  means,  to  pull  the  child  out 
and  through  the  vagina,  before  nature  has  had  time  to 
dilate  or  stretch  the  parts  sufficiently,  to  allow  the  child 


UNCLEANLINESS   A   CAUSE   OF    DISEASE.  85 

to  pass  through  the  maternal  organs  without  injuring  them. 
As  a  result  of  this  brutal  haste,  frightful  lacerations  are  in- 
curred, which  require  immediate  attention,  but  small  lacer- 
ations heal  without  any  further  treatment  than  to  keep  clean. 

After  every  confinement  there  is  considerable  sore  or 
raw  surface,  with  which  the  offensive  discharge  comes  in 
contact,  to  become  readily  absorbed  or  taken  up  into  the 
system,  giving  rise  to  fevers  or  inflammations  of  the  womb 
and  other  pelvic  organs.  If  one  has  a  wound  on  any  part 
of  the  body,  the  first  thought  would,  or  rather  should,  be  to 
keep  it  clean ;  exactly  the  same  treatment  is  required  for 
wounds  of  the  womb  and  vagina. 

When  the  discharge  becomes  offensive,  it  also  becomes 
dangerous  and  poisonous,  and  the  only  and  proper  thing  to 
do  is  to  thoroughly  wash  out  the  entire  vaginal  cavity  until 
all  offensive  smell  has  disappeared.  The  only  sure  sign 
that  anyone  can  have  of  the  completeness  and  thorough- 
ness of  the  vaginal  washings,  is  that  there  is  no  longer  any 
fetid  or  offensive  smell  perceptible. 

It  requires  no  particularly  trained  nurse  or  expert  to 
administer  a  cleansing  vaginal  injection,  yet  it  is  more 
likely  to  be  done  in  a  bungling,  inefficient  manner  than  in 
a  proper  workmanlike  manner;  for  this  reason,  it  would 
be  well  to  remember  a  few  of  the  necessary  details  of  carrying 
out  the  douching.  In  the  first  place,  the  room  in  which 
the  vaginal  douche  is  administered  must  be  comfortably 
warm,  so  as  to  preclude  the  possibility  of  chilling  the 
patient ;  the  windows  or  any  other  opening  liable  to  cause 
draft  must  be  closed.  The  nozzle  of  the  syringe,  whether  it 
be  a  fountain  or  a  family  syringe,  must  have  been  thor- 
oughly brushed  and  cleansed  with  soap  water,  before  and 
after  each  use ;  if  the  instrument  is  old,  or  has  been  used  for 
questionable  purposes,  or,  perchance,  made  the  rounds  of  the 
neighborhood,  it  had  better  be  thrown  into  the  ash  barrel,  and 
an  entirely  new  syringe,  the  "Alpha,"  be  employed,  which, 
by  its  sure  and  continuous  stream,  I  consider  the  most  suit- 


86  HOME   TREATMENT. 

able  female  syringe.  The  bulb  of  a  syringe  must  be  com- 
pressed in  the  palm  of  the  hand  slowly  and  deliberately. 

The  position  of  the  patient  is  of  considerable  importance; 
a  vessel  is  placed  under  her,  which  is  carefully  adjusted, 
so  as  not  to  tip  too  far  backwards,  otherwise  it  will  overflow 
and  drench  the  bed  or  the  patient's  clothing.  Beneath  the 
small  of  her  back  a  few  extra  pillows  are  placed,  and  thus 
she  comfortably  reclines  on  her  back,  while  the  attendant 
manages  the  disinfecting  wash  and  syringe,  placed  in  a 
basin  between  her  thighs.  Half  a  gallon  of  the  fluid  is 
usually  sufficient.  The  temperature  of  the  wash  is  very  im- 
portant and  may  range  between  103  and  106  degrees  Fah- 
renheit. 

The  recumbent  position  is  only  intended  for  women 
who  are  confined  to  their  beds ;  others,  who  are  around  and 
about  on  their  feet,  can  sit  comfortably  over  a  chamber,  on 
the  edge  of  a  low  chair,  having  the  vessel  underneath  them, 
and  the  wash  of  course  in  a  separate  basin.  In  the  course 
of  my  experience  I  have  been  called  to  mothers,  five  to  eight 
days  after  delivery,  who  were  in  a  raging  fever,  presumably 
from  the  ptomaines  which  had  developed  in  the  vagina  and 
poisoned  the  blood.  After  a  few  vaginal  injections,  some- 
times after  the  first,  the  fever  subsided  entirely.  These  re- 
markable results  we  owe  to  the  antiseptic  treatment  of  dis- 
ease, and  when  it  once  becomes  generally  known  that  this 
is  only  another  word  for  cleanliness,  infectious  diseases  will 
grow  correspondingly  less,  and  the  cure  for  those  that  exist 
will  be  less  experimental  and  more  reliable. 


CHAPTER    VI. 

MARITAL  EXCESSES  AND  PREVENTION  OF 
CONCEPTION. 

In  a  previous  chapter,  the  physiology  of  conception  was 
explained,  and  it  was  shown  to  be  an  organic  function,  in- 
dependent of  and  remote  from  the  sexual  act,  and  over  which 
the  parties  to  the  act  have  no  control.  From  this  scientific 
statement  of  the  actual  fact,  it  becomes  at  once  apparent  that 
conception  or  pregnancy  may  result  without  natural  sexual 
congress,  by  simply  injecting  the  sperm  of  the  male,  by 
means  of  a  uterine  syringe,  into  the  womb  of  the  female, 
while  she  is  in  a  state  of  unconsciousness.  It  is  also  quite 
probable  that  a  criminal  conspiracy  of  this  nature  could 
be  carried  out,  without  any  violation  to  the  delicate  anat- 
omy that  is  involved  in  the  natural  process;  a  detailed 
account  of  all  the  probabilities  which  the  ingenuity  of  a 
scientifically-trained  mind  could  devise,  belongs  more  prop- 
erly to  the  department  of  medical  jurisprudence.  It  is,  how- 
ever, of  sufficient  general  importance  that  the  reader  should 
have  at  least  an  idea  of  the  door  that  has  been  unlocked 
through  physiological  researches. 

What  we  are  at  present  endeavoring  to  make  clear  is, 
the  great  distinction  and  difference  between  coition  and  fe- 
cundation or  conception ;  while  one  is  but  the  result  of  the 
natural  instinct  aroused  by  the  senses,  the  other  reaches  out 
into  the  realm  of  the  Creator.  When  man  undertakes  to 
destroy  the  product  of  conception,  he  has  interfered  with 
the  prerogative  of  God  and  is  guilty  of  murder. 

The  question  may  now  naturally  arise  in  the  minds  of 
pure  and  morally-disposed  persons,  whether  there  is  any 

(87) 


88  HOME   TREATMENT. 

time,  without  doing  violence  to  God's  law,  that  the  children 
of  men  have  the  moral  right  to  control,  or  regulate,  the  pro- 
creation of  the  human  race?  If  I  answer  the  question  in 
the  affirmative,  I  will  then  proceed  to  inquire  into  the  ways 
and  means  to  that  end,  and  also  into  the  pernicious  methods 
that  are  employed,  to  accomplish  this  result. 

It  is  true,  that  the  Divine  command  was  to  be  fruitful 
and  multiply,  but  before  this  command  was  given,  man  was 
a  free  agent  and  a  reasoning  being,  which  implies  that  he  is 
after  all  to  be  the  judge  as  to  the  degree  in  which  this  com- 
mand is  to  be  carried  out.  That  is,  that  there  are  mitigating 
and  qualifying  circumstances,  which  man  has  not  only  a 
right  to  consider,  but  which  he  is  expected  to  take  into 
account  in  propagating  the  species,  b}r  virtue  of  his  reason- 
ing faculties. 

If  this  command  were  absolute  and  universal,  chaste 
celibacy  would  be  a  cardinal  sin,  yet  it  has  always  been  held 
by  the  canons  of  spiritual  growth  and  morality,  to  be  a  Di- 
vine virtue,  and  even  the  loving  Jesus  knew  not  woman,  be- 
cause the  forces  that  are  thus  expended  will  exert  their 
power  in  other  directions  and  towards  developing  powers  of 
a  higher  order. 

I  believe  that  a  moral  code,  which  is  too  exacting  to  be 
observed  by  the  average  person,  fails  to  accomplish  the  re- 
straint or  reform  that  is  desired,  so  that,  after  all,  it  becomes 
essential  to  lay  down  such  rules  as  the  average  men  or 
women  can  follow  as  guides  for  their  actions.  A  reformer, 
who  starts  out  with  the  broad  declaration  that  it  is  im- 
moral to  take  human  life,  and  a  murderous  act  to  destroy  a 
half-formed  human  being  in  its  mother's  womb,  and  that  it 
is  equally  murderous  to  prevent  the  recent  products  of  the 
sexual  act  from  becoming  a  viable  being,  fails  to  make  the 
impression  he  desires.  The  first  half  of  the  proposition  neu- 
tralizes the  second  of  its  sacred  essence,  in  placing  on  the 
same  level  the  organic  function  of  conception  and  the  ani- 
mal function  of  the  sexual  act. 


PREVENTION   OF   CONCEPTION.  89 

This  view  is  so  manifestly  absurd  to  the  person  of  even 
ordinary  perception,  that  I  feel  assured,  that  it  would  neither 
lessen  feticide  nor  sexual  excess. 

Spermatozoa  on  the  one  hand,  and  the  ova  of  the  female 
on  the  other,  are,  even  in  the  natural  and  uninterrupted 
course  of  nature,  destined  for  destruction,  for  whenever  the 
female  menstruates,  these  ova  are  discharged,  and  whenever 
the  male  copulates,  hundreds  of  spermatozoa  are  found 
swimming  in  the  spermatic  fluid,  which  in  case  there  be  no 
ripened  ovum  are  nothing  more  than  so  much  waste  secre- 
tion. Both  are  a  means  to  an  end,  and  that  end  is  the 
reproduction  of  the  species.  It  appears  to  me  a  flight  of 
fancy,  from  the  sublime  to  the  ridiculous,  to  assign  to  the 
sexual  act  the  same  importance  as  to  the  passive  function  of 
conception,  and  I  believe  that  doctrines  of  this  nature  lack 
not  only  the  least  scientific  support,  but  weaken  any  argu- 
ment in  favor  of  the  moral  or  spiritual  aspect,  which  alone 
raises  the  question  of  feticide  from  a  social  evil  to  a  mortal 
sin. 

Man  is  prompted  by  a  powerful  instinctive  desire  for  the 
use  of  the  sexual  organs,  that  draws  him  involuntarily  to 
the  opposite  sex,  not  for  the  continuance  of  the  race,  be- 
cause the  passion  arises  much  oftener  without  the  remotest 
thoughts  of  any  fruitful  results.  I  have  the  greatest  regard 
for  the  life  of  the  unborn  child,  yet  I  am  far  from  agreeing 
with  those  who  would  stamp  as  libidinous  every  thought  of 
the  sexual  instinct,  that  has  not  as  its  stimulus  the  pro- 
creation of  the  species.  While  the  average  man  is  in  the 
flesh,  he  is  an  animal  man,  and  there  is  no  use  of  trying  to 
make  a  spiritual  saint  out  of  flesh  and  blood,  and  when  we 
do  find  that,  we  have  a  very  exceptional  and  remarkable 
person.  But  what,  as  reasonable  beings,  we  should  do,  is  to 
bridle  the  animal  passions  with  moral  reins,  so  that  we  can 
stand  up,  in  full-statured  manhood,  with  the  respectful  ap- 
proval of  our  own  conscience,  able  to  rise  above  the  mere 
animal  appetites,  to  the  dignity  of  reasonable  beings.     This 


90  HOME   TREATMENT! 

instinct,  like  other  propensities,  is  excited  by  sensations,  and 
these  may  originate  either  in  the  sexual  organs  themselves, 
or  may  be  excited  through  the  organs  of  special  sense.  In 
man  the  passion  is  most  powerfully  aroused  by  impressions 
conveyed  through  the  sight  or  the  touch.  It  often  happens 
that  localized  sensations  will  excite  the  sexual  desire  of  either 
sex,  so  that  many  cases  of  excessive  sexual  desire  can  be 
traced  to  some  local  disease  of  the  genital  apparatus:  chief 
among  the  numerous  causes  that  may  be  cited,  is  pruritus  or 
local  itch,  erythema  and  active  congestion  of  the  womb  and 
ovaries. 

"This  tendency  cannot  be  regarded,"  says  Dr.  Carpen- 
ter, "as  a  simple  passion  or  emotion,  since  it  is  the  result  of 
the  combined  operations  of  the  reason,  the  imagination,  and 
the  moral  feelings :  it  is  in  this  engraftment  of  the  physical 
or  spiritual  attachment  upon  the  more  corporeal  instinct, 
that  a  difference  exists  between  the  sexual  relations  of  man 
and  those  of  the  lower  animals.  In  proportion  as  the  human 
being  makes  the  temporary  gratification  of  the  mere  sexual 
appetites  his  chief  object,  and  overlooks  the  happiness  aris- 
ing from  spiritual  communion,  which  is  not  only  purer  but 
more  permanent,  and  of  which  a  renewal  may  be  anticipated 
in  another  world, — does  he  degrade  himself  to  a  level  with 
the  brutes  that  perish.  Yet  how  lamentably  frequent  is  this 
degradation."  This  quotation  gives  the  entire  physical  and 
spiritual  aspect  of  the  question,  by  one  of  the  most  eminent 
physiologists  of  our  time,  so  that  in  the  natural  course  of  our 
investigation  we  are  led  to  inquire  into  the  currents  of 
thought,  which  would  tend  towards  developing  moral  re- 
straint. 

Moral  restraint  means  the  restraint  of  the  animal  man  by 
his  spiritual  or  higher  self;  the  will  must  possess  its  due  pre- 
dominance to  exercise  its  determining  power  in  curbing  the 
passions  of  the  one,  and  directing  the  course  of  the  thought 
in  the  other. 

The  cold,  calculating  materialist,  whose  ideal  is  circum- 


PREVENTION   OP   CONCEPTION.  91 

scribed  by  the  laws  that  have  been  deduced  from  the  phe- 
nomena of  the  material  world,  can  scarcely  appreciate  the 
higher  sentiments  that  are  involved  in  this  investigation, 
unless  he  becomes  changed  in  thought  and  feeling  to  the 
things  that  are  about  him.  To  accomplish  this  result  is 
hardly  within  the  scope  of  this  work.  With  the  average 
man  as  we  find  him,  my  observation  has  taught  me  that  it 
makes,  after  all,  little  difference,  whether  he  believes  in  a 
spiritual  nature  or  is  avowedly  materialistic.  The  great 
majority  of  men  and  women  live,  so  to  say,  in  the  turbulent 
waters  of  their  own  passions,  wafted  hither  and  thither  by 
the  impulses  of  emotional  excitement  and  instinctive  desires. 
There  is  little  or  no  hope  for  reform,  if  they  have  not 
sufficient  force  of  character  to  cry  halt,  and  stop  to  think 
a  little  upon  questions  which  are  to  them  of  the  greatest 
importance. 

Marital  excesses  are  the  mainspring  of  so  much  disease, 
that  ordinarily  is  attributed  to  quite  different  causes,  that 
this  chapter  would  be  very  deficient  were  I  to  omit  to  call 
the  attention  of  my  readers  to  this  fact.  The  men  on  the 
whole  are  oftener  the  victims  of  the  ill  effects  of  unbridled 
lust  than  the  women,  which  shows  itself  by  violent  and  un- 
controllable temper,  in  the  one  case,  and  stupid  docility  in 
the  other:  by  a  lean,  hungry,  nervous  appearance,  or  a  brut- 
ish, sanguineous  obesity;  extremes  of  the  different  tempera- 
ments and  habits  are  but  the  natural  outgrowth  of  the  con- 
stitution inherent  in  each  individual  case. 

Women,  as  a  rule,  are  more  passive,  less  amorous  and 
more  chaste  in  thought  and  feeling  than  men,  and  if  we 
define  emotion  as  an  idea  associated  with  pleasurable  or 
painful  feelings,  women  are,  as  far  as  appertains  to  their 
sexual  nature,  contrary  to  the  generally-accepted  opinion, 
much  less  emotional  than  men.  Continence,  among  the 
unmarried  women,  is  the  rule,  while  among  the  men  it  is 
the  rare  exception;  this  is  because  her  mill  is  by  nature 
stronger,  while  her  reason  is  weaker,  she  intuitively  arrives 
at  conclusions  that  are  her  guide  and  saviour. 


92  HOME   TREATMENT. 

It  is  a  prevalent  idea  among  men  that  the  marriage  cere- 
mony removes  all  restraint  from  the  exercise  of  the  sexual 
function ;  this  not  only  neutralizes  and  destroys  all  sentiment 
of  true  love,  which  seeks  for  the  happiness  of  the  object  it 
loves,  but  breeds  hatred  and  contempt.  To  be  permanently 
happy  and  mutually  respectful,  there  must  be  love  beyond 
the  pleasure  of  gratifying  the  mere  sexual  instinct,  there 
must  be  love  in  the  realm  of  thought  and  a  spiritual  com- 
munion above  the  instincts  of  the  flesh. 

"Any  warning  against  sexual  dangers,"  says  Dr.  Acton, 
"would  be  very  incomplete  if  it  did  not  extend  to  the  ex- 
cesses so  often  committed  by  married  persons  in  ignorance 
of  their  ill  effects.  Too  frequent  emissions  of  the  seminal 
fluid,  and  too  frequent  excitement  of  the  nervous  system,  are 
in  themselves  most  destructive.  The  result  is  the  same 
within  the  marriage  bond  as  without' it.  The  married  man 
and  woman  who  think  that  because  they  are  married,  they 
can  commit  no  excesses,  however  often  the  act  of  sexual  con- 
gress is  repeated,  will  suffer  as  certainly  and  as  seriously  as 
the  unmarried  debauchee,  who  acts  on  the  same  principle  in 
his  indulgences — perhaps  more  certainly,  from  their  very 
ignorance,  and  from  their  not  taking  those  precautions  and 
following  those  rules  which  a  career  of  vice  is  apt  to  teach 
the  sensualist.  Many  a  man  has,  until  his  marriage,  lived  a 
most  continent  life;  so  has  his  wife.  As  soon  as  they  are 
wedded,  intercourse  is  indulged  in  night  after  night,  neither 
party  having  an  idea  that  these  repeated  sexual  acts  are  ex- 
cesses which  the  system  of  neither  can  bear,  and  which  to 
the  man,  at  least,  is  absolute  ruin  and  to  the  woman  a  source 
of  disease.  The  practice  is  continued  till  health  is  impaired, 
sometimes  permanently,  and  when  a  patient  is  at  last  obliged 
to  seek  medical  advice,  he  is  thunderstruck  at  learning  that 
his  sufferings  arise  from  excesses  unwittingly  committed. 
Married  people  appear  to  think  that  connection  may  be  re- 
peated as  regularly  and  almost  as  often  as  their  meals.  Till 
they  are  told  of  their  danger,  the  idea  never  enters  their 


PREVENTION   OF   CONCEPTION.  93 

heads  that  they  are  guilty  of  great  and  almost  criminal  ex- 
cess; nor  is  this  to  be  wondered  at,  since  the  possibility  of 
such  a  cause  of  disease  is  seldom  hinted  at  by  the  medical 
man  they  consult.  Some  go  so  far  as  to  believe  that  in- 
dulgence may  increase  these  powers,  just  as  gymnastic  ex- 
ercises augment  the  force  of  the  muscles.  This  is  a  popular 
error,  and  requires  correction.  Such  patients  should  be 
told  that  the  shock  to  the  system,  each  time  connection  is 
indulged  in,  is  very  powerful,  and  that  the  expenditure  of 
seminal  fluid  must  be  particularly  injurious  to  organs  pre- 
viously debilitated.  It  is  by  this  and  similar  excesses  that 
premature  old  age  and  complaints  of  the  generative  organs 
are  brought  on." 

Wives  of  men  of  great  vital  force  are  not  long  before 
they  become  delicate,  sickly  and  nervous,  and,  entirely  igno- 
rant of  the  real  cause  of  their  feebleness,  seek  relief  by  tak- 
ing "a  good  iron  tonic,"  which  does  them  about  as  much 
good  as  if  they  had  left  it  alone,  the  tonic  effect  of  iron 
being  entirely  overestimated,  but  the  delusion  is  created  by 
associating  the  word  iron  with  the  idea  strength.  After  the 
different  tonics  have  been  tried,  the  patient  consults  a  phy- 
sician, who,  on  general  principles  and  after  a  hasty  exam- 
ination, informs  her  that  she  has  "  womb  disease."  These  two 
words  for  the  time  being  settle  the  question ;  she  now  be- 
gins "to  doctor,"  and  from  the  general  or  family  doctor  she 
finds  her  way  to  the  female  specialists,  who,  as  a  rule,  be- 
long to  the  recognized  magnifiers  and  humbugs  of  the  day. 
Here  she  becomes  one  of  the  regular  habitues  of  the  special- 
ist's waiting  room,  disappointed  and  not  a  little  discouraged. 
She  makes  the  rounds  of  the  most  prominent  of  them,  until 
she  has  been  doctored  out  of  her  dear  patience  and  her  still 
dearer  money.  Hope  is  often  a  forlorn  consolation,  and  if 
by  chance  she  now  takes  a  trip  to  the  country  or  undertakes 
a  long  visit  at  some  distance,  to  her  folks,  which  gives  the 
poor  woman  respite  from  the  "marital  rights"  of  her  Lord 
and  Master,  she  recovers  her   former  health,  strength  and 


94  HOME    TREATMENT. 

buoyancy.  Of  course  everybody  congratulates  her  upon 
the  wonderful  effect  of  the  climate,  when  the  climate  had  no 
more  to  do  with  her  recovery  than  the  moon.  The  re- 
markable change  was  owing  to  having  been  let  alone  by 
husband  and  doctor. 

That  the  attempt  to  call  attention  to  these  flagrant  abuses 
of  the  dishonesty  and  ignorance  of  the  one  and  the  blind 
animal  instinct  of  the  other  will  be  decried  and  stigmatized  as 
"  cranky,"  I  know  beforehand,  but  I  know  also,  that  those  who 
criticise  these  sentiments  are  fully  convinced  of  the  truth 
of  the  statement.  The  diseases  that  belong  to  this  class 
are,  like  most  uterine  diseases,  of  an  inflammatory  nature, 
and  for  that  reason  rest  is  one  of  the  most  essential  features 
in  the  treatment.  But  as  this  class  belongs  to  the  avoid- 
able causes,  prevention  is  much  better  than  cure.  I  there- 
fore advise,  as  of  first  importance,  to  abandon  the  American 
custom  of  man  and  wife  occupying  the  same  bed,  which  is 
only  customary  among  the  poorer  classes  of  Europe,  who  can- 
not afford  to  have  separate  beds  or  chambers.  The  advan- 
tage of  the  European  custom  in  segregating  one's  self  on 
retirement,  to  avoid  the  sexual  instincts  being  unduly  ex- 
cited, can  be  borne  out  by  remembering  the  physiology  of  the 
instinct,  which  we  were  told  is  excited  by  sight  and  feeling. 
Besides  these,  there  is  the  possible  undue  familiarity,  which 
the  joint  occupancy  of  the  chamber  or  bed  of  man  and  wife 
may  engender,  and  that,  too,  is  likely  to  lead  to  excessive  re- 
lations. 

All  efforts  to  exercise  voluntary  control,  by  prolonging 
the  sexual  act  or  extending  the  venereal  orgasm,  are  fraught 
with  the  most  pernicious  results  to  the  nerves,  termina- 
ting in  a  partial  or  complete  paralysis  of  the  different  or- 
gans of  the  body,  or  a  low  grade  of  inflammation  is  excited, 
which  offers  a  fruitful  soil  for  the  development  of  various 
diseases. 

A  man  who  has  become  the  husband  of  a  woman  should 
never  cease  to  be  a  gentleman  on  that  account,  nor  should 


PREVENTION    OF    CONCEPTION.  95 

he  become  lost  to  a  consideration  of  those  delicacies  of  re- 
finement, which  smooth  the  common  relations  in  the  exer- 
cise of  daily  duties. 

Continence  is  the  complete  restraint  from  sexual  indul- 
gence, which  in  its  fullest  sense  does  not  apply  to  the 
married  state,  but  it  comes  within  the  scope  of  every  mar- 
ried life  to  cultivate  and  practice  it  as  one  of  its  virtues. 
Every  married  couple  should  be  continent  for  days  and 
wreeks  at  a  time,  and  when  one  or  the  other  is  not  feeling 
well,  abstinence  should  be  practiced,  as  the  rule,  not  only  to 
avoid  a  nervous  shock,  which  may  have  serious  results,  but 
because  conception  in  an  abnormal  physical  condition,  will 
perpetuate  itself  in  the  child,  which  is  quite  likely  to  inherit 
a  nervous  or  sickly  constitution.  When  pregnancy  super- 
venes, undue  sexual  excitement  of  the  mother  often  lias  the 
most  serious  consequences  to  the  fetus,  and  may  result  in 
its  death,  or  induce  abortion. 

Diet  is  to  be  regulated,  to  assist  a  firm  determination 
to  lead  a  chaste  and  purer  life.  Stimulating  and  highly- 
seasoned  food,  and  alcoholic  beverages,  are  not  to  be  used,  be- 
cause they  increase  the  circulation  of  the  blood  and  stimu- 
late the  nerves  to  inflammatory  activity.  Meat  should  be 
eaten  only  once  a  day,  and  the  supper  should  be  bland  and 
light. 

Nature  has  set  a  time  during  which  continence  should  be 
practiced  for  the  purpose  of  preserving  the  health  and  con- 
trolling the  reproductive  function,  that  is,  the  menstrual 
period.  Menstruation  in  women  corresponds  to  the  ripen- 
ing and  discharge  of  the  human  ovule.  The  aptitude  for 
impregnation  is  a  day  or  two  before  and  six  to  eight  days 
after  the  courses  cease.  This  is  a  rule  which  applies  to  the 
great  majority  of  women,  and  if  the  sexual  relations  are  sus- 
pended from  a  few  days  before  the  onset  of  the  menses  until 
six  or  eight  days  after  the  flow  has  ceased,  the  chances  for 
pregnancy  are  reduced  to  the  minimum.  This  physio- 
logical  relation  of  the  organic  function  of  conception    to 


96  HOME   TKEATMENT. 

the  sexual  act  is  to  be  recommended  as  the  most  wholesome 
check  to  reproduction  in  early  married  life,  although  I  be- 
lieve that  there  is  no  time  better  calculated  to  raise  a  family 
than  while  you  are  young  and  hopeful. 

Children  are  common  objects  of  love  and  hope  for  both 
parents.  Life  and  health  are  ever  changing  the  relations  of 
our  surroundings,  and  when  newly-married  people  put  off 
to  the  dim  future  the  hopes  of  rearing  a  family,  they  are 
often  doomed  to  everlasting  disappointment.  Nature  is  ca- 
pricious and  jealous  of  her  prerogatives,  and  those  who  trifle 
with  her  functions  must  expect  to  be  frustrated  in  the  end, 
and  have  no  one  but  themselves  to  blame  if  she  fails  to  re- 
spond to  their  capricious  wishes.  Children  make  trouble  of 
course,  so  were  we  as  troublesome  in  our  time,  but  there  is 
also  a  great  deal  of  pleasure  in  watching  them  grow  from 
day  to  day  in  bodily  strength  and  mental  perception,  which 
no  amount  of  selfish  enjoyment  can  compensate. 

The  diseases  that  are  brought  upon  women  by  the  differ- 
ent practices  and  mechanical  devices  to  prevent  conception 
are  too  numerous  to  mention  in  a  work  of  this  character. 
Some  of  the  methods  are  absolutely  loathesome  to  all  sense 
of  decency  and  reduce  sexual  intercourse  much  below  the 
instinctive  indulgence  of  the  brute;  these  debauches  of  the 
conjugal  bed  not  only  sap  the  vitality  of  the  participants, 
but  must  lower  or  destroy  all  mutual  respect,  and  ultimate 
in  dissension  and  strife,  which  the  divorce  court  will  finally 
assuage. 

Referring  to  the  practice  of  conjugal  onanism  or  inter- 
rupted or  incomplete  coitus,  Dr.  Franklin  Devay  says: 
"  However,  it  is  not  difficult  to  conceive  the  degree  of  per- 
turbation that  a  like  practice  should  exert  upon  the  genital 
system  of  woman  by  provoking  desires  which  are  not  gratified ; 
a  profound  stimulation  is  felt  through  the  entire  apparatus; 
the  uterus,  Fallopian  tubes  and  ovaries  enter  into  a  state  of 
orgasm,  a  storm  which  is  not  appeased  by  the  natural  crisis;  a 
nervous  super-excitation  persists.     There  occurs,  then,  what 


PREVENTION   OF   CONCEPTION.  97 

would  take  place  if,  presenting  food  to  a  famished  man,  one 
should  snatch  it  from  his  mouth  after  having  thus  violently 
excited  his  appetite.  The  sensibilities  of  the  womb  and  the 
entire  reproductive  system  are  teased  for  no  purpose.  It  is 
to  this  cause,  too  often  repeated,  that  we  should  attribute  the 
multiple  neuroses,  those  strange  affections  which  originate  in 
the  genital  system  of  women.  Our  conviction  respecting 
them  is  based  upon  a  great  number  of  observations.  Fur- 
thermore, the  normal  relations  existing  between  the  married 
couple  undergo  unfortunate  changes;  this  affection,  formed 
upon  reciprocal  esteem,  is  little  by  little  effaced  by  the  repeti- 
tion of  an  act  which  pollutes  the  marriage  bed ;  from  thence 
proceed  certain  hard  feelings, certain  deep  impressions,  which, 
gradually  growing,  eventuate  in  the  scandalous  ruptures  of 
which  the  community  rarely  know  the  real  motive."  This 
is  in  every  respect  as  hurtful  as  the  vicious  practice  of 
solitary  vice,  although  that  is  comparatively  less  common 
among  young  virgins  than  among  those  of  the  opposite  sex. 
Nevertheless,  this  is  a  frequent  cause  of  hysterical  symptoms 
and  uterine  disease.  Stop  it  at  once;  there  is  no  burden  that 
a  large  family  of  children  can  impose  upon  you,  be  it  even 
poverty  and  want,  as  great  as  the  inevitable  results  of  these 
unnatural  habits. 

The  use  of  caps  or  tissue  coverings,  made  of  thin  rubber 
or  gold-beater's  skin,  are  not  only  suggestive  of  the  licentious- 
ness of  the  brothel  but  their  employment  causes  physical  le- 
sions from  their  irritating  friction  to  the  walls  of  the  vagina. 
I  have  had  under  my  treatment  obstinate  ulcerations  of  the 
vagina  which  were  due  to  their  use,  and  in  one  instance  it 
degenerated  into  cancer.  The  use  of  the  "womb  veil,"  which 
originated  in  France,  has  been  denounced  as  a  fruitful  source 
of  ulceration  of  the  womb,  by  modern  French  writers,  who 
are  more  familiar  with  their  indiscriminate  employment 
than  Americans.  There  has  been  also  a  plug  or  stem  pes- 
sary employed  for  the  purpose  "of  sealing  up  the  womb," 
which  is  partly  introduced  into  the  mouth  and  cervical  canal 
7 


98  HOME    TREATMENT. 

of  the  organ;  this  obviously  adds  insult  to  injury,  by  also 
irritating  the  cavity  of  the  womb  and  exciting  inflamma- 
tion of  its  lining  membrane.  There  are  other  devices  for 
a  similar  purpose,  that  have  the  same  tendency  of  irritating 
and  wounding  the  genitals  of  the  female. 

There  is  nothing  that  could  be  said,  to  intimidate  some 
women,  by  forewarning  them  of  the  danger  of  their  preven- 
tive measures;  they  will  continue  to  make  business  for  the 
specialists,  and  drain  the  purses  of  their  husbands,  but  there 
is  a  great  majority  of  good,  noble,  matronly  women  who  are 
pure  in  heart  and  mind,  that  appreciate  the  value  of  the  in- 
formation that  I  impart.  What  I  desire  to  further  suggest, 
is  a  preventive  measure  that  is  entirely  harmless  and  con- 
sistent with  chastity  and  cleanliness,  for  I  believe  that  within 
certain  bounds,  a  woman  has  a  moral  right  to  limit  or  con- 
trol the  conception  of  her  womb.  But  right  here  the  option 
ceases.  If  she  pushes  her  measures  beyond  the  portals  of 
the  womb,  if  she  employs  medicines  or  mechanical  devices 
to  bring  around  her  courses,  when  she  suspects  pregnancy 
or  conception,  she  becomes  a  murderess  in  the  eyes  of  the 
Creator.  The  bowl  of  tanzy  tea,  or  any  of  the  many  quack 
nostrums,  advertised  in  the  public  prints,  are  as  much  an 
instrument  of  murder  as  the  probe  of  the  abortionist.  It  would 
be  the  height  of  sophistry  to  make  a  distinction  between  the 
embryo  of  an  hour  or  a  day  old,  and  that  of  any  future 
period.  The  potentiality  of  a  human  being  is  established 
at  the  moment  of  conception,  and  the  destruction  of  this,  at 
any  period,  is  homicide.  No  one  can  deny  less  importance 
to  the  cause,  which  is  conception,  than  to  the  effect,  which  is 
the  human  embryo,  for  without  the  one,  the  other  is  impos- 
sible. 

Hence,  not  to  bear  a  child  implies  not  to  conceive  a 
child,  for  if  once  conceived,  it  must  be  born. 

The  reasons  that  may  exist  for  limiting  the  progeny  of 
each  particular  pair  cannot  be  formulated  into  a  code,  for 
these  are  questions  of  conscience,  between  the  individuals  and 


PREVENTION   OF   CONCEPTION.  99 

their  Creator,  on  the  one  hand,  and  on  the  other,  they  should 
be  influenced  by  economic  conditions  and  physical  or  con- 
stitutional taints  of  the  progenitors.  I  do  not  believe  in  the 
truth  of  the  law  of  Malthus,  that  there  is  a  tendency  for 
population  to  increase  faster  than  the  means  of  subsistence, 
but  I  am  inclined  to  the  view  held  by  John  Stuart  Mill,  that 
■"no  one  has  a  right  to  bring  children  into  life  to  be  sup- 
ported by  other  people."  But  when  the  same  eminent  au- 
thority designates  the  procreative  act  as  brute  instinct,  I 
think  he  is  in  great  error,  for  that  is  not  so.  Conjugal  affec- 
tion and  the  sentiment  of  love  spring  from  the  reproductive 
systems,  through  the  reflex  action  of  the  brain,  and  these 
have  their  moral  significance,  and  should  not  be  branded  as 
brutal,  for  upon  their  normal  functions  depends  the  perpet- 
uation of  the  race,  and  as  it  was  so  ordained  by  the  Creator, 
it  cannot  be  an  unholy  passion. 

To  be  physically  strong  and  well  are  the  prerequisites 
for  happiness,  and  if  we  cannot  transmit  to  our  offspring  this 
•essential  quality,  it  would  be  much  better  for  society  if  we 
were  not  instrumental  in  bringing  defective  children  into 
the  world.  The  competitive  struggle  for  existence  is  hard 
■enough  for  the  vigorous  and  robust;  how  much  greater 
must  it  be  for  the  constitutionally  infirm?  When  these  con- 
ditions of  infirmity  exist,  they  should  influence  our  course  as 
progenitors;  this  appears  to  me  self-evident,  and  I  trust  in 
the  wisdom  that  is  innate  to  the  human  soul,  that  only  the 
best  ends  will  be  subserved. 

An  expedient  that  is  to  accomplish  the  object  in  view, 
must  be  in  the  nature  of  a  wholesome  sanitary  measure, 
that  violates  no  law  of  nature.  The  inordinate  use  of  any 
preventive,  coupled  with  excessive  indulgence,  cannot  be 
without  ill  effects.  Excesses  must  be  studiously  avoided,  so 
as  not  to  incur  the  diseases  of  which  mention  has  already 
been  made.  The  employment  of  a  vaginal  douche  of  the 
proper  temperature,  medicated  with  a  little  pure  alcohol,  is 
not  injurious  and  is  the  most  reliable  of  all  preventives, 


100  HOME   TREATMENT. 

provided  it  is  intelligently  used  and  without  delay.  The 
quantity  of  fluid  to  be  used  is  a  quart  of  warm  water,  of 
103  to  105  degrees  Fahr.,  to  which  two  tablespoonfuls  of 
alcohol  is  added ;  of  this,  three-fourths  or  all  is  to  be  douched 
through  the  vagina. 

The  vaginal  irrigation  is  to  be  undertaken  immediately 
after  the  act;  if  sufficient  time  is  allowed  to  pass,  the  sper- 
matozoa will  have  entered  the  mouth  of  the  womb;  then 
they  are  clearly  beyond  the  reach  of  the  wash.  The  warm 
water  and  the  necessary  paraphernalia  are  to  be  held  in 
readiness  so  as  to  lose  no  time  in  making  the  toilet,  nor 
should  there  be  unnecessary  exposure  to  the  danger  of  catch- 
ing cold.  The  nozzle  of  the  syringe  should  always  be  of 
hard  rubber,  because  that  is  not  likely  to  rust  or  corrode. 
The  syringe  is  to  be  kept  scrupulously  clean  b}T  means  of 
occasional  brushings  in  soapy  water.  Vaginal  injections 
should  never  be  taken  in  the  morning,  if  the  person  is  re- 
quired to  exercise  on  her  feet,  and  for  the  same  reason, 
should  any  husband  have  marital  relations  with  his  wife 
before  rising  in  the  morning,  the  wife  is  likely  to  suffer 
all  day,  either  by  soreness  or  pain  or  by  a  dragging  sensa- 
tion of  the  womb  and  vagina. 

The  same  rule  is  to  be  followed  in  vaginal  irrigation  as 
for  other  purposes,  the  main  point  being  to  throw  the  fluid 
well  up  into  the  vagina,  and  that  can  only  be  done  if  the 
nozzle  is  carried  directly  backward  and  not  upwards.  No 
violence  or  force  is  to  be  used,  under  any  circumstance. 


CHAPTER  VII. 

CRIMINAL  ABORTION  OR  FETICIDE. 

I  have  so  far  endeavored  to  give  a  cursory  description  of 
avoidable  causes,  which  were  inadvertantly  or  thoughtlessly 
encouraged,  and  it  is  to  be  hoped  that  my  friendly  reproof 
and  counsel  will  incite  my  readers  to  modify  their  pernicious 
habits  and  direct  the  currents  of  their  thoughts  into  chan- 
nels more  or  less  in  harmony  with  the  hygiene  that  I  have 
been  at  liberty  to  suggest. 

There  are  few  persons,  if  any,  who  would  voluntarily  act 
and  think  in  a  manner  that  would  be  prejudicial  to  their 
physical  or  moral  welfare,  if  they  were  educated  to  a  stand- 
ard of  knowledge  that  gave  them  an  insight  into  the  evil 
consequences.  The  law  of  self-preservation  is  innate  in  our 
natures,  so  that  we  are  ready  to  cultivate  the  good  and  use- 
ful and  shun  that  which  may  do  harm. 

Among  the  avoidable  causes  there  is  none  so  prolific  of 
disease  as  that  which  is  traced  to  the  premature  expul- 
sion of  the  ovum  or  fetus  from  the  mother's  womb. 

This  appears  self-evident,  when  we  stop  to  consider  that 
the  function  of  rej^roduction  is  at  once  by  far  the  most  com- 
plicated of  the  physiological  processes  of  the  female  economy, 
so  that  its  sudden  interruption  will  naturally  induce  any  one 
or  all  of  the  physical  or  pelvic  ailments  which  we  are  called 
upon  to  discuss. 

For  our  purpose  it  will  not  be  sufficient  to  consider  the 

subject  from  a  medical  standpoint  alone,  because  the  thoughts 

drift  involuntarily,  as  it  were,  from  the  physical  into   the 

metaphysical,  from  the  material  into  the  spiritual  part  of 

our  nature. 

(101) 


102  HOME    TREATMENT. 

It  is  not  within  the  scope  of  this  work  to  enter  upon  an 
inquiry  into  the  scientific  evidence  of  the  existence  of  the 
soul  or  advance  any  argument  whatever  in  support  of  that 
doctrine,  but  I  assume  the  existence  of  an  immortal  soul  to 
be  a  fact, 

What  I  will  endeavor  to  explain  is  when  and  where  this 
mystic  union  of  the  soul  with  the  body  takes  place?  Here 
the  speculations  of  the  medical  philosophers  have  been  con- 
tradictory, on  account  of  attributing  to  the  fetus  different 
kinds  of  life,  that  is,  an  organic  or  vegetating  existence  at- 
tached to  the  mother's  womb,  and  as  such  not  possessed  of 
sentient  principle,  until  the  real  or  spiritual  life  imbues  the 
fetus,  when  it  becomes  a  living  soul. 

Hippocrates,  the  most  famous  physician  of  antiquity, 
who,  even  in  the  light  of  the  nineteenth  century,  looms  up  as 
one  of  the  most  brilliant  intellects  that  the  world  ever  had, 
lent  the  weight  of  his  judgment  to  this  very  unreasonable 
doctrine. 

He  supposed  that  animation  occurred  from  thirty  to 
forty-two  days  after  conception. 

The  Stoics  went  still  further  and  maintained  that  there 
was  no  vitality  until  after  birth  and  the  establishment  of  res- 
piration. 

The  Academicians  were  of  the  opinion,  that  life  was  im- 
parted to  the  fetus  during  the  period  in  which  the  mother 
carried  it  in  the  womb,  but  they  could  not  agree  on  the  time 
when  it  began.  Even  the  Roman  Church,  which,  in  the  main, 
is  right  on  this  question,  speaks  of  animate  and  inanimate 
fetuses.  When  it  is  remembered  that  there  was  no  scien- 
tific physiology  upon  which  the  ancients  based  their  opinions, 
it  is  not  at  all  surprising  that,  in  the  light  of  modern  research, 
they  are  shown  to  be  all  wrong. 

There  is  no  time  during  the  child's  sojourn  in  the  mother's 
womb  that  life  is  less  active  than  at  another,  and  any  opin- 
ion to  the  contrary  is  manifestly  absurd  and  unscientific. 

I  appreciate  the  distinction  between  physical  life,  or  vital 


CRIMINAL   ABORTION   OR   FETICIDE.  103 

activity,  and  spiritual  life,  but  the  one  must  necessarily  be 
in  the  other. 

A  central  fountain  of  physical  force  is  consistent  with 
scientific  deductions,  and  physicists  are  inclined  to  admit 
such  a  source.  Many  of  the  phenomena  of  the  material 
world  are  explained  upon  this  hypothesis.  The  sun  is  sup- 
posed to  be  that  central  fountain  of  physical  force  which  in- 
spires activity  in  matter  on  this  planet.  Matter  in  itself  is 
inert  and  motionless ;  the  globe  we  inhabit  has  no  energy  in 
itself  which  could  keep  it  in  motion,  but  the  forces  playing 
on  and  around  it  impart  to  it  its  motive  power. 

The  life  of  any  complex  organism,  such  as  that  of  man, 
is  in  fact  the  aggregate  of  the  vital  activity  of  all  its  com- 
ponent parts,  and  each  elementary  part  of  the  fabric  has  its 
own  independent  power  of  growth  and  development.  If  we 
contemplate  the  history  of  the  life  of  a  plant,  we  perceive 
that  it  grows  from  a  germ  or  seed  to  a  fabric,  sometimes  of 
gigantic  size, — it  multiplies  its  species,  by  the  production  of 
germs  similar  to  that  from  which  it  originated.  This  it 
performs  without  feeling  or  thinking  or  any  effort  of  its  own. 
All  the  functions  of  which  its  life  is  composed  are  grouped 
together  under  the  general  designation  of  organic  functions, 
or  vegetative  life. 

In  the  building  up  of  the  animal  structure  we  have  pre- 
cisely the  same  operations  taking  place,  one  minute  cell 
added  to  the  other,  like  the  stone  mason  running  up  a  brick 
wall,  each  brick  representing  a  cell,  until  the  structure  is 
completed. 

The  question  that  we  are  particularly  interested  in  is 
whether  this  "animal  life"  which  stimulates  the  growth  of 
the  fetus  from  its  first  inception,  can  be  any  the  less  sacred 
at  one  time  than  at  another? 

There  is  a  general  impression  among  a  large  portion  of 
the  community  that  the  fetus  first  becomes  endowed  with 
life  at  the  period  of  quickening,  which  is  between  the  fourth 
and  fifth  month  of  pregnancy.     The  time  when  the  mother 


104  HOME   TREATMENT. 

first  feels  the  motion  is  considered  the  period  when  the  child 
becomes  animated,  that  is,  when  it  receives  its  spiritual 
nature  into  union  with  its  human  nature. 

The  English  law  recognized  the  truth  of  this  infamous 
doctrine,  in  varying  the  punishment  of  an  attempt  to  procure 
abortion  according  to  whether  the  woman  be  "quick  with 
child  or  not,"  and  in  delaying  execution  when  a  woman 
can  be  proved  to  be  so,  though  the  execution  is  made  to  pro- 
ceed, if  she  be  not  "quick,"  even  if  she  be  unquestionably 
pregnant.  This  was  a  most  barbarous  penal  provision  and 
hardly  excusable  in  a  savage  nation,  much  less  among  a 
Christian  people,  because  it  is  contrary  to  all  fact,  to  all  anal- 
ogy, to  reason,  and  at  variance  with  biological  science. 

If  the  embryo  or  fetus  is  simply  an  animal  growing  in 
the  mother's  womb,  until  the  period  of  quickening  or  birth, 
it  would  not  be  a  crime  to  procure  an  abortion,  at  any  time, 
before  these  events  take  place.  No  sacrifice  of  a  human  life 
would  be  involved,  so  that  the  act  would  be  simply  a  "mis- 
demeanor" regulated  by  the  degree  of  injury  which  the 
mother  sustained  as  a  result  of  the  operation.  This  was  the 
prevailing  opinion  for  many  centuries,  until,  in  the  year  692, 
the  Roman  Empire  so  amended  its  law  that  the  procuring  of 
an  abortion  at  any  time  during  the  period  of  gestation 
was  homicide,  murder,  to  be  punished  with  death. 

France  patterned  after  the  Roman  law  for  a  time  and 
made  criminal  abortion  punishable  by  inflicting  the  death 
penalty ;  during  the  French  revolution  this  law  was  amended 
by  imprisonment  for  life ;  and  later,  under  Napoleon,  in  1810, 
the  law  was  again  changed,  and  the  punishment  lessened. 

In  England  there  has  been  a  gradually  growing  moral 
sentiment  to  protect  the  defenseless  child  in  its  mother's 
womb,  so  that  to-day  England  has  so  amended  her  law  that 
the  fetus  has  the  same  protection  in  the  uterus  before  as 
after  quickening,  so  that  a  conviction  for  the  procurement  of 
criminal  abortion  at  any  time  during  gestation  from  con- 
ception until  birth  is  felony  and  punished  by  imprisonment 
or  transportation. 


CRIMINAL   ABORTION   OR   FETICIDE.  105 

In  Germany  the  law  makes  abortion  a  State  prison  of- 
fense, and  public  opinion  is  in  such  a  healthy  state  there 
that  anyone  justly  accused  of  this  crime  is  quite  sure  to 
meet  with  a  punishment. 

In  America  legislation  on  this  subject  differs  widely  in 
the  different  States.  In  Massachusetts  the  barbarous  dis- 
tinction, "  before  quickening  and  after,"  was  still  recognized 
a  few  years  ago,  so  that  the  crime  of  abortion  before  quick- 
ening was  not  an  indictable  offense.  In  some  of  the  States 
the  laws  are  stringent  and  conform  with  the  physiological 
facts  of  fetal  life,  but,  like  most  of  our  "  good  laws,"  they  are. 
observed  only  in  the  breach. 

The  essential  peculiarity  in  the  process  of  reproduction 
is  the  absorption  of  a  small  cell  of  the  male,  the  spermato- 
zoon, by  another  small  cell  of  the  female,  the  ovum.  This 
coalescence  of  the  two,  male  and  female  cells,  is  the  fertiliza- 
tion of  the  ovum,  and  constitutes  conception. 

The  spermatic  fluid  of  the  male  holds  in  suspension  a 
large  number  of  very  small  bodies,  or  cells,  which,  from  their 
usually  remaining  in  active  motion  for  some  time  after  they 
have  quitted  the  human  body,  have  been  erroneously  con- 
sidered animalcules.  A  more  thorough  familiarity  with 
these  bodies,  and  careful  microscopic  examinations,  can  dis- 
tinguish nothing  in  the  nature  of  structure  within  them. 
They  are  simply  little  oval,  flattened,  transparent  cells  be- 
tween the  one-six-hundredth  and  one-eight-hundredth  of 
an  inch  in  length,  having  a  little  thread-like  "  tail,"  grad- 
ually tapering  to  a  fine  point. 

These  measurements  make  the  spermatozoa  consider- 
able larger  than  the  average  red  blood-corpuscle,  which  is 
one-thirty-two-hundredths  of  an  inch  in  diameter. 

The  spermatic  fluid  of  a  single  emission  of  a  healthy 
male  contains  thousands  of  these  little  ciliated  cells,  the  cilia 
or  tails  of  which  are  seen  in  an  active  vibratile  modulatory 
motion,  in  the  field  of  the  microscope,  wriggling  hither  and 
thither,  like  a  school  of  frightened  fishes.    This  lashing  mo- 


106  HOME   TREATMENT. 

tion  is  continued  for  hours,  and  under  favorable  circum- 
stances for  days.  In  the  cases  of  microscopical  examinations 
of  vaginal  secretions  of  married  women,  for  causes  of  sterility, 
I  was  able  to  establish  their  activity  thirty-six  hours  after 
marital  relations. 

Through  this  peculiar  lashing  motion  the  ciliated  cells 
are  propelled  onward  and  upward,  through  the  mouth  and 
cervix  of  the  womb,  thence  along  its  body  to  the  openings 
of  the  Fallopian  tubes,  along  which  they  migrate  to  the  ova- 
ries of  the  female.  In  a  healthy  condition  of  the  female  gen- 
erative organs,  hundreds  of  spermatozoa  arrive  at  the  ova- 
ries about  the  same  time,  a  few  hours  or  days  after  copulation, 
but  as  the  ova  ripen  and  are  discharged  only  at  regular  in- 
tervals, the  hundreds  of  ciliated  bodies  that  travel  thither 
are  doomed  to  disappointment,  and  gradually  lose  their  vi- 
tality, and  perhaps  are  removed  by  absorption. 

Of  all  these  hundreds  of  germs  it  requires  only  a  single 
one  to  combine  with  an  ovum,  or  a  similar  little  cell  of  the 
female,  to  constitute  conception.  When  this  combination  has 
been  accomplished,  a  new  being  is  inaugurated,  another  hu- 
man soul  is  started  out,  by  the  magic  wand  of  nature,  to 
go  through  the  different  spheres  of  evolution,  of  whose 
ultimatum  we  can  have  no  clear  conception,  but  this  is  per- 
fectly clear,  that  after  this  coalescence  of  the  two  germs,  the 
die  is  cast  and  the  female  becomes  then  only  the  vehicle  in 
which  the  creative  forces  are  effecting  their  elaboration. 

Coition  and  conception  are  widely  different  processes, 
and  require  to  be  separately  analyzed  to  be  understood. 

Coition  is  always  a  physical  act,  a  gratification  of  the 
senses,  and,  like  many  other  human  passions,  is  often  abused 
by  excessive  indulgence,  degenerating  into  lust. 

Conception,  on  the  other  hand,  is  purely  passive,  an  or- 
ganic function,  without  consciousness  on  the  part  of  the  fe- 
male. 

Thus  far  there  is  a  similarity  in  the  organic  processes  of 
conception  in  all  mammalia,  so  that  their  embryos  cannot 


CRIMINAL   ABORTION   OR   FETICIDE.  107 

be  classified  and  assigned  to  their  respective  species  in  the 
early  stages  of  their  development.  Physiologists  are  unable 
to  say  whether  the  one  belongs  to  and  will  ultimately  de- 
velop into  a  brute  animal  or  a  human  being,  yet  one  has  the 
attributes  of  mental  force,  the  elements  of  a  soul,  while  the 
other  is  to  follow  a  blind  instinct,  without  the  possibility  of 
spiritual  perception.  Conception,  in  the  one  case,  is  simply 
a  vegetative  or  organic  function,  while  in  the  other  there  is, 
in  addition,  a  spiritual  effort  to  individualize  a  human  soul. 

The  creative  energy  of  nature  is  separate  and  independ- 
ent of  the  sexual  act,  for  it  does  not  take  place  during  copu- 
lation of  the  sexes,  nor  immediately  after  it,  but  hours  or  days 
after  the  act  is  accomplished. 

I  am  often  called  upon  to  say  when  and  where  the  hu- 
man soul  becomes  associated  with  the  human  body? 

There  is  a  divine  life,  or  spiritual  energy,  that  animates 
the  soul  from  the  spiritual  realm.  It  is  the  correspondency 
of  the  physical  force  that  animates  the  physical  body. 

The  term  or  phrase  which  I  employ  to  designate  this 
force  is  of  less  importance  than  the  definition  which  is  given 
to  it,  and  upon  this,  of  course,  we  must  agree.  I  recognize  in 
such  an  energy  or  power,  the  primal  cause  or  force,  behind 
and  beyond  the  phenomena  of  nature.  This  force  must  be 
universal  and  omnipresent,  hence  spiritual;  it  must  be  the 
central  source  of  supply  for  all  spiritual  things,  so  that  the 
doctrine  of  Paul  is  scientifically  in  harmony  with  a  ration- 
alistic view  of  the  subject,  when  he  says  "  in  Him  we  live 
and  move  and  have  our  being." 

The  science  of  the  conservation  of  forces  teaches,  that 
forces  are  never  lost,  that  they  are  indestructible  and  eternal. 
We  derive  our  spiritual  existence  from  this  central  spiritual 
sun  and  inherit  the  quality  of  eternity  with  it.  Mind  is 
spirit  and  the  soul  is  mind;  this  is  the  view  of  Spinoza, 
who,  in  the  second  part  of  his  work  "  Ethics,"  employs  the 
terms  synonymously  throughout  the  chapter  "  Of  the  Na- 
ture and  Origin  of  the  Mind  or  Soul."     Mind  differentiates 


108  HOME   TREATMENT. 

man  from  the  inferior  animal  creations,  and  can  make 
him  what  he  will. 

Professor  Carpenter  in  his  "  Principles  of  Human  Physiol- 
ogy," tells  us,  that  when  we  first  discern  the  primordial  cell, 
which  is  to  evolve  itself  into  the  human  organism,  we  can 
trace  nothing  that  essentially  distinguishes  it  from  that 
which  might  give  origin  to  any  other  form  of  organic  struc- 
ture. The  earliest  stages  of  its  development  consist  in 
simple  multiplication  of  cells  by  "  duplicative  subdivision," 
so  that  a  mass  of  cells  comes  to  be  produced,  amidst  the 
several  components,  of  which  no  difference  can  be  traced; 
and  this  also  finds  its  parallel  among  the  simpler  organisms 
of  both  kingdoms.  There  is  nothing  at  this  period  to  dis- 
tinguish the  germs  of  man  from  that  of  any  other  verte- 
brated  animal,  yet  in  the  course  of  nine  short  months  a 
human  being  is  developed  possessing  all  the  faculties  of  its 
progenitor,  and  how  could  all  this  come  to  pass,  if  not  in- 
stituted at  the  moment  of  conception? 

It  is  at  this  time  and  moment,  that  an  atom  of  the  uni- 
versal spirit  becomes  separated  and  individualized,  and  the 
germ  of  a  human  soul  is  implanted,  deep  in  the  dark  re- 
cesses of  nature's  laboratory.  The  ovum  of  the  female 
and  the  germ  of  the  male  coalesce,  imbued  by  the  in- 
carnation of  the  immortal  spirit,  and  no  time  can  be  more 
opportune  for  that  union  than  at  the  very  inception  of  our 
being,  because  the  soul  and  the  body  must  interact,  one  on 
the  other. 

In  the  reproduction  of  man,  there  is  a  higher  purpose 
than  simply  to  multiply  the  species.  The  Creator  can  only 
manifest  Himself,  if  he  has  intelligent  souls  or  spirits  as 
his  creatures,  and  the  reproduction  of  the  human  species  is 
the  natural  means  of  bringing  this  about. 

The  mystic  union  is  accomplished  at  the  time  and  mo- 
ment of  conception,  when  a  unit  of  the  universal  spirit  be- 
comes individualized  into  a  human  soul.  In  the  dark  recesses 
of  the  mother's  womb  the  ovum  of  the  female  and  the  germ 


CRIMINAL   ABORTION   OR    FETICIDE.  109 

of  the  male,  imbued  by  the  immortal  spirit,  begin  their 
growth  and  development  together,  this  constitutes  the  triune 
of  nature,  from  which  the  evolutions  of  body  and  soul  take 
their  beginning. 

Sexual  instinct  is  not  an  unholy  and  depraved  action  of 
the  human  mind,  but  the  necessary  means  to  an  end,  a  fi- 
nite instrumentality  of  the  Divine  mind  to  procreate  the 
body,  as  an  abode  for  the  human  soul.  One  of  the  attri- 
butes of  the  Creator  is,  in  the  very  nature  of  things,  to  create, 
and  he  has  thus  endowed  us,  His  creatures,  for  the  manifes- 
tation of  His  creative  power.  He  perpetually  and  eternally 
creates,  and  this  has  no  reference  to  time,  place  or  space: 
just  as  in  the  beginning,  God  created  all  things,  so  we  rec- 
ognize the  supreme  hand,  now,  to-day,  and  forever,  ever 
active  in  His  natural  element. 

The  operation  of  nature's  law  may  be  contravened  by 
the  selfish,  sordid,  criminal  acts  of  the  human  heart,  but  it 
cannot  be  frustrated.  No  one  can  console  himself,  that  the 
invincible  law  of  evolution  is  at  the  capricious  behest  of  fi- 
nite man,  and  can  be  neutralized  and  obstructed  at  will; 
that  would  place  a  limitation  on  the  Creator ;  it  would  con- 
tradict the  omnipotence  of  the  Divine  mind;  it  would  place 
every  life  or  soul  at  the  mercy  of  the  sordid  conscienceless 
abortionist,  and  it  would  reduce  the  Divine  origin  of  man 
and  the  soul's  immortality  to  an  absurdity. 

After  the  fetus  is  murdered,  its  soul  continues  to  grow 
in  the  spiritual  realm,  an  undying  witness  of  the  criminal 
infamy  which  deprived  it  of  that  earthly  experience  which 
nature  intended  for  the  children  of  men.  It  is  the  greatest 
crime  against  nature  to  kill  off  a  human  fetus,  and  prema- 
turely hurl  into  eternity  a  human  soul,  which  has  the  same 
right  to  human  experience  as  those  already  born,  and,  in 
the  eyes  of  God,  it  is  no  less  a  crime  than  the  murder  of 
an  adult. 

"Dust  thou  art,  to  dust  returnest, 
Was  not  spoken  of  the  soul." 


110  HOME   TREATMENT. 

The  meaning  of  the  term  abortion  is  etymologically 
not  to  be  born  or  not  to  be  carried  out,  or,  in  other  words, 
the  premature  expulsion  of  the  fetus  from  its  mother's 
womb,  which  is  any  time  before  it  is  capable  of  independent 
existence.  This  is  according  to  the  construction  of  the  law 
of  France,  which  means  any  time  previous  to  the  termina- 
tion of  the  sixth  month  of  pregnancy.  Abortion  may  be 
accidental,  that  is,  it  may  be  due  to  a  casualty  which  was 
entirely  beyond  the  control  of  the  person  suffering  or  going 
through  an  abortion,  or  it  may  be  due  to  disease  affecting 
either  the  embryo  or  the  mother. 

The  word  "  miscarriage  "  is  generally  preferred  to  that  of 
"  abortion  "  under  the  misconception  that  only  the  latter 
implies  criminal  culpability;  this,  of  course,  is  an  error,  be- 
cause each  word  means  exactly  the  same  thing,  with  this 
difference,  that  one  is  of  Latin  origin,  while  the  other  is  a 
plain  Anglo-Saxon  term.  An  abortion  that  is  brought  about, 
from  other  than  natural  causes,  for  the  deliberate  and  avowed 
purpose  of  escaping  from  the  inconvenience,  privation,  and 
cares  of  maternity,  is  always  qualified  by  the  adjective  crim- 
inal. 

In  the  early  months  of  pregnancy,  it  very  seldom,  though 
it  occasionally  does  happen,  that  complications  arise  which 
place  the  life  of  the  mother  in  imminent  danger ;  that  the  em- 
bryo shares  this  danger  in  a  corresponding  degree  is  self- 
evident,  because  the  fetus  is  unable  to  live  independently  of 
the  mother  any  time  before  the  expiration  of  the  sixth 
month  of  gestation,  so  that  the  death  of  the  mother  means 
death  to  the  fetus  also. 

Through  a  fall,  heavy  lifting,  or  a  sudden  jar,  a  partial 
detachment  is  liable  to  occur  between  the  placenta  of  the  fe- 
tus and  the  wall  of  the  mother's  womb,  that  being  the  place 
where  the  blood  of  the  one  is  exchanged  into  the  blood  of 
the  other;  from  this,  a  hemorrhage  may  result,  which  will 
not  yield  to  rest  nor  to  other  means  which  experience  has 
taught  to  be  useful.  This  loss  of  blood  may  be  so  great 
that,  if  it  continues,  the  life  of  both  will  be  sacrificed. 


CRIMINAL    ABORTION    OR    FETICIDE.  Ill 

In  some  women  pregnancy  may  become  complicated 
with  convulsions;  these  may  be  so  violent,  and  recur  so  often, 
as  to  threaten  life,  and  they  are  obstinate  to  all  medicinal 
resources. 

Contingencies  of  the  above  nature  evoked  the  scientific 
inquiry,  whether  abortions  are  ever  justifiable.  The  answer 
must  invariably  be,  that  when  it  is  clearly  seen  that  the 
mother  will  surely  die,  and  her  fetus  with  her,  an  induced 
abortion  becomes  a  justifiable  obstetric  resource,  and  under 
these  circumstances  it  is  not  a  crime  nor  even  a  sacrifice  of 
the  embryo,  which  would  have  perished  with  the  mother. 

This  rule  of  practice  has  been  indorsed  by  the  very 
highest  authority  in  obstetric  science,  and  the  competent 
conscientious  physician  will  readily  draw  the  line  between 
cases  where  so  radical  a  measure  becomes  necessary,  and 
where  milder  conservative  measures  will  save  the  life  of 
both  mother  and  child. 

This  cannot  be  a  license  for  crime,  except  that  the  sor- 
didly depraved  time  server  may  often  try  to  stretch  the 
threatening  danger,  but  when  this  is  done  it  is  no  less  a 
crime  of  murder  in  the  eyes  of  God,  than  if  he  had  premed- 
itatedly  and  willfully  slain  a  fellow-being. 

Such  persons  would  not  shrink  from  the  perpetration  of 
any  crime,  be  it  ever  so  heinous  and  black.  These  wretches 
are  too  cowardly  to  thrust  a  poinard  into  their  victims  on 
the  highway,  but  ever  ready  to  operate  in  secrecy  in  the 
abortion  chamber,  which  is  hidden  from  the  eyes  of  man. 
I  have  known  abortions  being  sought  and  abortions  being 
committed,  upon  the  flimsy  pretext  of  being  too  weak,  or 
too  sick  at  the  stomach.  These  are  shallow  subterfuges, 
that  should  not  be  countenanced  by  any  conscientious  prac- 
titioner. 

Many  reasons  are  either  imaginary  or  pretended,  and  I 
have  often  proved  the  fallacy  of  pretensions  of  an  inability 
to  carry  a  child,  after  women  had  gone  through  the  abor- 
tion mills,  by  persuading  them  to  become  reconciled,  for 


112  HOME   TREATMENT. 

the  time  being,  and  that  I  would  see  them  through  to  a 
happy  end,  and  in  no  case  were  their  fears  justified  by  sub- 
sequent developments.  There  is  a  great  deal  in  controlling 
the  minds  of  these  women,  and  directing  them  into  whole- 
some channels  of  thought,  and  after  that  they  become  much 
happier  and  contented  than  ever  before  in  their  married 
lives. 

If  the  proposition  is  generally  accepted,  that  abortions 
are  justifiable  as  a  therapeutical  expedient,  you  open  the 
door  to  the  criminally  inclined.  Wily  women  will  impose 
upon  inexperienced  practitioners  by  feigning  physical  suf- 
fering as  a  result  of  pregnancy,  for  the  purpose  of  getting 
rid  of  their  fetuses.  There  is  a  certain  amount  of  hardship 
and  discomfort  associated  with  the  average  pregnancy  for  a 
part  of  the  period  at  least,  but  this  should  be  suffered  with 
a  mother's  fortitude. 

The  testimony  of  the  early  canons  of  the  Catholic  Church 
is  very  decisive  on  the  crime  of  abortion,  namely,  "  that  the 
destruction  of  the  fetus  in  the  womb  of  its  parent,  at  any 
period  from  the  first  moment  of  conception,  is  a  crime  equal 
in  turpitude  to  murder." 

In  Protestant  countries  abortions  are  on  the  increase,  and 
in  America  it  is  one  of  the  crying  crimes  of  society,  which 
has  so  thoroughly  tainted  and  defiled  the  moral  sense  of 
American  communities,  that  it  has  become  next  to  impossi- 
ble to  get  a  jury  of  twelve  men  who  will  agree  on  a  verdict 
to  punish  this  dastardly  foul  crime  of  murder,  and  the  abor- 
tionist is  thus  encouraged  in  his  iniquitous  vocation. 

Professor  J.  Taber  Johnson,  of  Maryland,  stated  in  his 
annual  oration  before  the  State  Medical  Society :  "  The  diffi- 
culty of  conviction  for  producing  abortion  is  shown  in  the 
statement  of  the  Attorney-General  of  Massachusetts,  that  of 
thirty -two  arrests  and  trials  of  abortionists  in  that  State,  in  a 
period  of  eight  years,  not  a  single  conviction  resulted ;  and 
this  fact  is  equally  true  of  other  States."  This  is  indeed  a 
sad  commentary  on  the  jury  system,  which  often  degener- 
ates into  a  farce  or  travesty  on  justice. 


CRIMINAL   ABORTION   OR   FETICIDE.  113 

The  practice  of  abortion  is  on  the  increase.  This  is  not 
due  to  a  single  cause,  but  to  a  number,  operating  separately 
or  co-operating  jointly  to  the  same  end.  Boarding-house 
or  hotel  life  exercises  a  pernicious  influence  on  the  habits 
and  morals  of  women.  They  sit  all  day  in  their  apartments 
with  indifferent  occupations,  or  walk  the  streets  between 
meal  hours,  without  the  inspiring  thoughts  which  a  cozy 
home  alone  can  inspire.  The  maternal  instinct  languishes 
or  dies  completely  out,  and  if  women  become  pregnant 
while  transiently  domiciled,  they  scruple  not  against  com- 
mitting this  great  crime,  because  their  surroundings  and 
accommodations  may  not  be  suitable  for  the  changed  rela- 
tions which  motherhood  brings  about.  If  these  people  had 
their  own  little  homes,  were  they  ever  so  humble,  their 
minds  would  run  in  different  grooves,  their  lives  would  be 
much  happier  and  offspring  longingly  desired,  to  fill  the 
nooks  in  the  little  household. 

Want  of  domestic  training  in  childhood  lays  the  foun- 
dation for  this  crime.  The  American  girl  is  trained  with  a 
view  to  display  so-called  refined  accomplishments.  This  is 
done  by  totally  ignoring  domestic  duties;  these  are  to  be 
shunned  as  menial  and  degrading;  and  when  girls  grow 
into  womanhood  and  are  married,  they  naturally  look  upon 
the  ordinary  household  duties  as  drudgery,  and  quite  un- 
becoming a  woman  of  their  attainments.  There  is  nothing 
in  their  bosoms  to  arouse  a  pride  in  their  homes ;  quite  the 
reverse ;  that  principle  has  never  been  inculcated  in  their 
youth,  so  that  it  is  quite  natural,  that  they  hie  to  a  boarding- 
house  ;  here  they  patronize  the  abortionist,  or  acquire  pro- 
ficiency in  that  art  themselves,  from  lack  of  nobler  occupa- 
tion. 

Changed  relations  of  the  sexes  destroy  the  maternal  in- 
stinct. A  man  in  a  man's  place,  and  a  woman  in  the 
sphere  for  which  God  and  nature  intended  her,  is  for  the 
best  interests  of  society.  There  is  useful  and  profitable 
work  for  everyone,  but  each  should  labor  in  his  or  her  re- 
8 


114  HOME   TREATMENT. 

spective  field  of  natural  adaptability,  in  which  there  is 
plenty  to  do.  There  is,  in  the  very  nature  of  things,  never 
anything  gained  by  a  woman  doing  a  man's  work,  because 
there  are  always  plenty  of  men  around  to  do  that,  but  while 
a  woman  is  doing  a  man's  work,  she  is  necessarily  neglect- 
ing a  woman's,  which  it  is  physically  impossible  for  any 
man  to  do  for  her.  There  is,  consequently,  an  irretrievable 
loss  to  society  from  misapplied  labor.  When  the  great 
Napoleon  was  asked  by  Madam  de  Stael  whom  he  consid- 
ered the  greatest  woman  in  France,  his  curt  reply  was,  "  She 
who  bore  the  largest  number  of  children."  This  is  a  tribute 
to  motherhood,  which  no  one  can  ridicule,  for  whom  should 
we  honor  and  respect  more  than  the  faithful,  loving  mother, 
who  makes  her  life  subservient  to  that  of  her  children? 
There  is  no  comparison  between  the  self-denial  of  parental 
devotion  and  the  devotee  to  amusements  and  fashion,  or 
the  slothful  wife,  who  imposes  sterility  upon  herself  for  the 
sake  of  pandering  to  depraved  appetites  and  frivolous  pleas- 
ures. 

Depraved  associates  pave  the  way  to  feticide.  Some 
married  women  are  so  brazen  and  callous,  that  they  have 
no  delicacy  in  narrating  their  exploits  of  child  murder 
with  a  triumphant  air,  whenever  their  acquaintances  are 
patient  and  foolish  enough  to  listen  to  them.  These  gad- 
ding persons  often  contaminate  the  minds  of  newly-married 
women,  who  had  never  for  a  moment  entertained  the 
thought  of  such  an  awful  crime,  and  who  would  have  made 
happy  and  contented  mothers,  were  it  not  for  the  seeds  of 
discontent  and  crime  which  were  sown  in  their  early  mat- 
rimonial career.  I  have  known  mothers  who  had  lost  the 
delicate  maternal  instincts,  without  which  a  mother  becomes 
a  monster,  advise  their  daughters  and  encourage  them  in 
the  perpetration  of  this  crime. 

Women  of  this  type  should  be  avoided  like  the  dreaded 
mancanilla  tree,  for  they  poison  the  body  and  soul  of  pure, 
virtuous  women,  with  whom   they  come  in   close  contact; 


CRIMINAL   ABORTION   OR   FETICIDE.  11 5. 

they  should  be  shunned  by  the  young  housewife  like  a  pes- 
tilence, because  their  hands  are  scarlet  with  the  blood  of 
their  own  children. 

Unprincipled  physicians  are  too  often  instrumental  in 
abetting  criminal  abortions,  and  this  for  two  reasons,  namely, 
for  the  immediate  lucre  which  is  to  them  in  hand  paid,  and 
also  for  ingratiating  themselves  into  the  confidence  of  their 
patrons,  so  that  they  may  become  their  physician  in  other 
ailments.  These  are  the  pariahs  of  the  profession,  but, 
viewed  from  a  business  standpoint,  they  are  very  successful. 
It  is  through  the  looseness  with  which  medical  colleges  are 
•conducted  in  this  country,  many  of  them  not  deserving  the 
name  of  college,  but  more  properly  denominated  a  rendez- 
vous of  self-constituted  professors  and  ingenious  advertising 
sharps,  that  the  ranks  of  the  profession  are  overcrowded,  be- 
cause there  is  no  scrutiny  of  moral  character  or  professional 
attainments.  These  once  labeled  M.  D.'s  are  determined  to 
make  a  professional  living,  and  nothing  deters  them  from 
becoming  particeps  criminis,  but  owing  to  the  corrupt  and 
depraved  jury  system  such  a  thing  as  punishing  a  physician 
for  feticide  is  hardly  ever  heard  of.  I  would  advise  my 
readers  to  shun  each  and  every  one  of  these  criminal  mon- 
sters as  they  would  a  pestilence.  In  general,  "female  spe- 
cialist" is  but  another  name  for  abortionist,  for  the  great 
majority  of  these  self-constituted  specialists  do  not  know 
the  rudiments  of  the  science  of  gynecology;  and  women 
should  exercise  great  precaution  in  whose  hands  they  place 
themselves,  or,  rather,  their  lives.  I  know  of  no  calling 
that  is  capable  of  rendering  more  good  to  humanity  than 
the  profession  which  I  have  made  my  own. 

The  honorable  physician  occupies  a  position  where  he 
•can  do  a  great  deal  to  improve  the  tone  and  morality  of  the 
community.  He  can  do  more  than  the  pulpit  in  prevent- 
ing feticide,  because  he  can  depict  the  physical  dangers  and 
the  moral  turpitude,  for  it  is  to  him  that  the  deluded  woman 
£rst  goes  for  advice.     It  is  with  him  to  become  an  oracle  of 


110  HOME    TREATMENT. 

heaven;  in  the  great  majority  of  instances  he  can  be  instru- 
mental in  saving  human  life  and  prevent  the  mother  from 
murdering  her  own  child. 

Maternity  is  the  function  of  Divinity  in  human  nature. 
Who  can  look  upon  a  newly-born  babe  without  seeing  some- 
thing truly  Divine,  a  manifestation  of  the  Divine  mind  to 
create  in  his  image,  through  the  instrumentality  of  man,  an 
innocent  human  flower,  planted  upon  this  earth  to  enjoy  the 
fullness  thereof,  and  what  miscreant  shall  deny  it  its  inher- 
itance ? 

That  husbands  are  often  the  instigators  of  this  crime  is 
a  fact  well  known  to  every  physician  of  experience.  I  have- 
known  of  a  number  of  cases  where  wives  came  to  my  office 
with  a  woful  tale  of  discontent  on  the  part  of  their  hus- 
bands, who  did  not  want  an  "increase."  Such  men  are  not 
worthy  the  name  of  father  or  husband.  They  should  have 
been  emasculated  before  they  ever  approached  the  marriage 
altar,  for  they  are  below  the  brute  creation  and  have  no 
claim  on  human  affections.  The  luxuries  of  life  should  not 
be  considered  as  weighing  against  the  birth  of  children,  nor 
the  expense  of  maintaining  a  large  family  considered  as  an 
excuse  for  feticide ;  expenses  had  better  be  reduced  and  econo- 
mized in  other  directions,  so  as  to  meet  the  little  extra  in- 
crease, which  the  little  stranger  may  cause.  It  is  a  fact,  that 
among  thrifty  people,  large  families  are  no  barrier  to  mate- 
rial success,  for  the  blessedness  of  heaven  rests  upon  them. 

I  invariably  solicit  an  interview  with  the  recalcitrant 
spouse,  and  take  the  opportunity  to  tell  him  of  the  responsi- 
bilities which  married  life  imposes  upon  married  couples; 
that  the  simple  gratification  of  the  carnal  senses  is  lust, 
which  can  and  should  be  controlled  by  every  person,  and 
more  in  particular  by  married  men.  Matrimonial  relations 
based  only  on  libidinous  pleasure  are  transient  and  eva- 
nescent ;  incompatabilities  arise,  which  cause  conflict  and 
dissension,  ultimating  in  estrangement  and  divorces,  but 
when  soul  is  wedded  to  soul,  then  they  are  in  harmony  with 


CRIMINAL   ABORTION   OR    FETICIDE.  117 

the  music  of  the  spheres,  and  children  constitute  the  cement 
of  an  eternal  wedlock  which  no  man  can  rend  asunder. 

Abrupt  termination  of  pregnancy  constitutes  in  itself  a 
diseased  process  in  the  tissues  of  the  womb.  We  have  al- 
ready learned  of  the  gradual  growth  of  the  body  of  the  womb 
to  accommodate  the  growth  of  the  child ;  when  abortion 
takes  place  there  is  a  sudden  check  to  this  growth  in  the 
tissues  of  the  womb,  and  a  low  grade  of  inflammation  in- 
vades the  entire  structure.  This  inflammatory  process  fixes 
•or  hardens  the  womb  so  that  this  acquired  enlargement 
often  becomes  permanent.  The  result  is,  that  women  can 
often  trace  the  beginning  of  a  long  series  of  complaints  and 
a  shattered  constitution  to  a  so-called  miscarriage.  For  this 
reason,  the  after-treatment  of  an  abortion  is  of  much  greater 
importance,  than  after  a  regular  normal  delivery. 

After  the  close  of  a  natural  gestation,  the  child  is  born, 
and  nature  immediately  sets  to  work  to  restore  the  womb  to 
its  healthy  normal  size.  No  violence  having  been  done  to 
the  organ,  there  is  no  extra  effort  necessary  on  the  part  of 
nature  to  restore  it.  In  a  premature  expulsion  of  the  fetus, 
it  is  altogether  different,  the  cell  growth  and  the  necessary 
physiological  action  to  build  up  the  womb,  to  house  the  rap- 
idly-developing fetus,  was  suddenly  interfered  with,  and  the 
shock  which  the  vital  activity  sustains,  diverts  their  ener- 
gies into  a  diseased  process.  Inflammation  is  to  be  guarded 
against,  for  it  constitutes  the  root  of  all  pathological  condi- 
tions; chief  among  them  is  its  prevention  of  fatty  degenera- 
tion and  absorption  of  the  superfluous  tissues  of  the  organ, 
so  that  the  womb  remains  heavy  and  enlarged.  This  en- 
tails a  series  of  consequences ;  its  size  and  weight  may  force 
it  to  occupy  an  unnatural  and  painful  position,  such  as  a 
falling  of  the  womb  or  procidentia,  or  it  may  turn  or  even 
bend  on  itself  into  abnormal  positions,  called  versions  and 
Jlexions;  these  become  obstinate  to  treatment  in  proportion  to 
the  time  which  elapses  from  the  occurrence  of  the  disease  to 
the  time  when  they  fall  under  proper  treatment. 


118  HOME   TREATMENT. 

Inflammations  are  limited  sometimes  to  only  portions  of 
the  organ;  this  may  be  to  the  lining  mucous  membrane  of 
either  the  body  or  neck.  It  may  also  invade  the  entire  or- 
gan and  even  extend  to  the  neighboring  tissues  and  liga- 
ments. From  the  uterus  along  the  Fallopian  tubes  to  the 
ovaries  inflammation  may  spread  itself,  causing  abscesses  in 
its  wake  and  other  complications  which  may  require  surgi- 
cal skill  of  a  special  nature  to  give  permanent  relief. 

Sterility  is  often  the  result  of  disease  caused  by  abortion, 
and  this  should  be  another  warning  to  thoughtless,  giddy 
women,  who  desire  no  children  in  their  early  married  life,, 
because  it  would  interfere  with  their  regular  pleasure  rounds, 
and  so  resort  to  abortions,  which  will,  in  all  probabil- 
ity, make  them  entirely  unfit  to  ever  become  pregnant  or 
bear  children.  I  have  made  an  attempt  to  impress  on  the 
reader  two  things;  one  of  these  is  the  flagrant  violation  of  or- 
dinary and  simple  rules  of  health,  the  other  the  enormity  of 
the  crime  of  induced  abortions,  and  to  accomplish  this  I 
have  avoided  screening  the  subject  by  employing  ambiguous 
or  finely-selected  phrases,  but  have  used  plain  terms  which 
will  not  shock  the  pure  or  noble  in  heart  and  mind,  but  may 
the  hypocritical,  under  the  gauze  of  a  false  modesty. 


PLATE  I. 


The  Bony  Pelvis  in  its  relation    to  the  entire  body. 

From  the  author's  original  drawing. 


CHAPTER  VIII. 

ANATOMY  OF  THE  FEMALE  ORGANS. 

The  bony  part  of  the  skeleton  which  is  of  particular 
interest  to  women,  is  the  pelvis,  so  called,  because  it  forms  a 
basin  or  cavity  which  contains  the  most  important  female 
organs  of  generation. 

All  the  organs  that  are  liable  to  the  diseases  of  women, 
bear  certain  anatomical  relations  to  the  pelvis,  so  that  the 
phrase,  pelvic  diseases  of  women,  is  often  employed  instead  of 
the  phrase,  diseases  of  women,  and  pelvic  surgery  means  also, 
surgical  procedures,  that  may  be  employed  for  the  relief  or 
cure  of  these  diseases. 

In  confinement,  the  pelvis  again  comes  into  more  or  less 
prominence,  for  when  the  diameters  of  the  pelvic  canal  have 
not  their  normal  measurements,  there  is  likely  to  be  an  ob- 
struction to  the  passage  of  the  child  into  the  world,  so  that 
mechanical  means  must  be  employed  to  overcome  the  obsta- 
cle. A  broad  pelvis  in  a  woman  is  always  a  guarantee  that 
there  will  be  no  insurmountable  difficulty  in  the  parturient 
act. 

Plate  I  shows  the  shape  and  locality  of  the  bone  in  the 
human  body,  and  gives  also  an  approximate  idea  of  the 
relation  of  the  pelvis  to  the  rest  of  the  body. 

While  the  pelvis  was  referred  to  above  as  a  basin  or 
cavity,  this  is  only  partly  true,  for  it  is  also  a  canal  or  pas- 
sageway, through  which  the  child  is  born.  The  pelvis  is 
divided  by  a  prominent  line  into  the  false  and  true  pelvis. 

The  False  Pelvis  is  all  that  expanded  portion  of  the 
pelvic  cavity  which  is  above  the  rim  or  line  that  forms  a 

(119) 


120  HOME   TREATMENT. 

circular  ridge,  wnich  marks  the  beginning  of  the  bony- 
canal  to  which  the  term  true  pelvis  is  applied. 

The  True  Pelvis  constitutes  the  lower  subdivision  of 
the  pelvic  cavity.  The  circular  ridge,  which  marks  the 
division,  constitutes  also  the  inlet  of  the  true  pelvis,  which  is 
much  smaller  than  the  upper  or  false  pelvis.  Its  walls  are 
more  perfect  and  their  lower  circumference  is  very  irregular 
and  forms  what  is  called  the  outlet.  Between  the  inlet  and 
the  outlet  we  have  what  is  called  the  true  pelvic  cavity,  in 
which  the  internal  female  generative  organs  are  contained. 

These  organs  are  located  in  the  following  order  from  before 
backwards :  first,  behind  the  pubis  there  is  the  bladder,  and 
behind  this  is  the  uterus,  and  thirdly  and  a  little  to  the  left 
is  the  rectum. 

On  each  side  of  the  womb,  but  also  in  the  small  or  true 
pelvis,  are  the  Fallopian  tubes  and  ovaries. 

In  this  order  the  anatomical  relations  are  easily  remem- 
bered, and  I  believe  that  every  woman  should  make  it  an 
object  to  learn  at  least  as  much  of  her  own  anatomy  as  I 
have  laid  down;  because  there  is  just  little  enough,  so  as  not 
to  make  it  tiresome,  and  quite  enough  to  insure  intelligent 
reading  in  the  subsequent  chapters. 

The  points  of  differences  between  the  male  and  female 
pelvis  are  entirely  on  the  principle  of  adaptation  to  natural 
functions.  The  female  pelvis  has  a  broadness  or  greater 
prominence  of  the  hips  and  a  correspondingly  greater  pelvic 
cavity,  while  that  of  the  male  is  altogether  more  massive. 

Its  cavity  is  deeper  and  narrower,  and  the  muscular 
eminences  and  impressions  on  the  surfaces  of  the  bones  are 
much  stronger  marked. 

Plate  II.  This  illustrates  a  cut  or  section,  through  the 
middle  of  the  pelvis,  from  before  backwards,  so  as  to  give  a 
side  view  of  the  capacity  of  the  true  pelvis  and  of  the  organs 
that  it  contains.  A  careful  study  of  this  plate  will  per- 
manently fix  the  anatomy  in  the  reader's  mind. 

The  lines  a  and  b  show  the  planes  of  the  inlet  and  out- 


PLATE  II. 


A  Median  Section  of  the   female   Pelvis  and  of  the   Organs 
that  are  centrally  located. 

This  plate  is  anatomically  correct;    the  uterus  resting-  normally  on  and  lx-intr 
elevated  by  the  distended  bladder. 


ANATOMY  OF  THE  FEMALE  ORGANS.         121 

let  of  the  true  pelvis,  and  it  will  be  seen  that  within  these 
lines  the  most  important  organs  of  the  female  are  located. 

THE   BLADDER. 

The  bladder  is  situated  at  the  anterior  part  of  the  pelvis. 
It  is  in  relation,  in  front  with  the  symphysis  pubis,  behind 
with  the  womb,  some  convolutions  of  the  small  intestines 
being  interposed;  its  base  lies  in  contact  with  the  neck  of 
the  uterus  and  with  the  anterior  wall  of  the  vagina.  The 
bladder  is  said  to  be  larger  in  the  female  than  in  the  male, 
and  is  very  broad  in  its  transverse  diameter. 

THE    URETHRA. 

The  urethra  is  a  narrow  membranous  canal,  about  an 
inch  and  a  half  in  length,  extending  from  the  neck  of  the 
bladder  to  the  external  orifice.  It  is  placed  beneath  the 
symphysis  pubis,  embedded  in  the  anterior  wall  of  the  vagina, 
and  its  direction  is  obliquely  downwards  and  forwards.  Its 
diameter,  when  undilated,  is  about  a  quarter  of  an  inch; 
behind  the  bladder  and  urethra,  there  is  in  regular  order  the 
uterus  and  vagina,  and  behind  both  of  these,  the  rectum. 

THE    PERINEUM. 

The  Perineum  is  the  muscular  triangular  body  between 
the  vagina  and  rectum ;  it  constitutes  a  segment  of  the  female 
pelvic  floor;  it  is  the  prop  for  all  the  pelvic  organs,  and  for 
that  reason  every  woman  should  know  precisely  what  it  is, 
and  study  the  plate  carefully  until  she  understands  it.  The 
skin  covering  it  is  of  a  dark  color,  thin  and  freely  movable 
over  the  underlying  parts.  There  is  no  part  of  the  pelvic 
anatomy  so  vulnerable,  because  in  confinement  during  the 
passage  of  the  child's  head  into  the  world,  the  perineum  is 
put  on  a  great  stretch,  and  if  the  delivery  progresses  too 
quickly  or  is  hurried,  then  the  tissues  have  no  time  to 
stretch  themselves  so  as  to  accommodate  the  child's  head, 
and  they  must  naturally  tear. 

The  awkward  and  officious  use  of  instruments  will  do 
the  same  thing.  I  have  seen  the  perineum  torn  asunder 
from  this  cause,  from  the  vagina  and  back  into  the  rectum. 


122  HOME   TREATMENT. 

Plate  III  is  one  of  the  most  instructive  drawings  that  I 
could  devise.  It  gives  the  reader  a  practical  illustration 
of  the  internal  generative  organs  and  their  anatomical  re- 
lations to  each  other.  This  was  a  drawing  from  my  own 
dissection,  and  the  clearness  and  artistic  reproduction  is  due 
to  the  skill  of  the  engraver,  Mr.  H.  X.  Van  de  Casteele,  of 
this  city. 

the  vagina. 

The  vagina  is  a  membranous  canal,  extending  from  the 
vulva  or  introitus  to  the  uterus.  It  is  situated  in  the  cavity 
of  the  pelvis,  between  the  bladder  in  front  and  the  rectum 
behind;  its  direction  is  not  in  a  straight  line,  but  curved 
from  below  backwards  and  upwards.  When  distended  it  is 
cylindrical  in  shape,  but  naturally  it  is  flattened  from  before 
backwards,  so  that  its  walls  are  ordinarily  in  contact  with 
each  other.  In  length  it  averages  about  four  inches  in  its 
anterior  wall,  while  its  posterior  wall  describes  a  segment  of 
a  larger  circle,  that  makes  it  between  one  and  two  inches 
longer.  At  its  commencement  it  is  constricted,  and  at  its 
upper  extremity,  where  it  is  attached  to  the  womb,  it  is 
dilated,  so  as  to  surround  the  vaginal  portion  of  the  neck  of 
the  womb  (see  Plate  III,  c)  this  is  a  short  distance  above  the 
mouth  of  the  womb.  The  attachment  extends  higher  up  on 
the  posterior  than  on  the  anterior  wall  of  the  womb,  which 
makes  the  posterior  lip  of  the  womb  longer  than  the  anterior. 

The  mucous  membrane  is  continuous  above  with  that 
covering  the  vaginal  portion  of  the  uterus ;  below  it  begins 
at  the  vulva.  Running  longitudinally  along  the  anterior 
and  posterior  walls  are  distinct  ridges  or  raphe;  these  are  the 
columns  of  the  vagina. 

The  relations  of  the  vagina  to  the  neighboring  organs 
can  be  studied  to  better  advantage  by  referring  to  Plate  I. 

Its  anterior  surface  is  concave,  and  is  in  relation  with  the 
base  of  the  bladder  and  with  the  urethra.  Its  posterior 
surface  is  convex  and  connected  to  the  anterior  wall  of  the 
rectum  for  the  lower  three-fourths  of  its  extent,  the  upper 


PLATE 


The  Vagina  slit  open  to  the  neck  or  Cervix  of  the  Uterus, 
showing:  the  insertion  of  the  latter  into  the  former. 


From  the  author's  own  design,  beautifully  illustrating: 

a.  Fundus  (or  Base    of  the  Uterus.  //.   Perineum. 

b.  Uterus"  Body.  it.  Round  Ligaments. 

c.  Cervix,  or  Neck.  klc.  Broad  Ligaments. 

d e.  Vatfinal  part,  forminy  the  Anterior        //.   Uterine  Vessels  and  Nerves. 

and  Posterior  Lips.  mm.  Fringed  Extremity  of  the  Fallopian 
f.  Mouth  of  the  Womb.  Tubes. 

gg.  Interior  of  Vagina,  illustrating  the  it  it.  Fallopian  Tubes. 

Vaginal  Folds.  oo.  Ovaries. 


ANATOMY   OF   THE   FEMALE   ORGANS.  12i> 

fourth  being  separated  from  the  tube  by  a  fold  of  the  perito- 
neum, the  recto-uterine  fold,  which  forms  a  cul-de-sac  between 
the  vagina  and  rectum.  Its  sides  give  attachment  superiorily 
to  the  broad  ligaments,  and  inferiorily  to  the  Levatores  Ani 
muscles  and  recto-vesical  fascia. 

THE   UTERUS   OR   WOMB. 

The  uterus  is  the  organ  of  gestation,  receiving  the  fecun- 
dated ovum  in  its  cavity,  retaining  and  supporting  it  during 
the  development  of  the  fetus,  and  becoming  the  principal 
agent  in  its  expulsion  at  the  time  of  parturition.  In  the  vir- 
gin state  it  is  pear-shaped,  flattened  from  before  backwards, 
and  situated  in  the  cavity  of  the  pelvis,  between  the  bladder 
and  the  rectum.  It  is  retained  in  its  position  by  the  round 
and  broad  ligaments  (Plate  III,  ii  and  kk)  on  each  side,  but 
also  by  virtue  of  its  anteverted  position,  and  by  the  vagina  and 
perineum.  Its  upper  end  or  base  (a)  is  directed  upwards 
and  forwards;  its  lower  end,  or  apex,  is  directed  downwards 
and  backwards  in  the  line  of  the  axes  of  the  inlet  of  the 
pelvis.  It  therefore  forms  an  angle  with  the  vagina.  The 
uterus  measures  about  three  inches  in  length,  two  in  breadth 
at  its  upper  part,  and  an  inch  in  thickness,  and  it  weighs 
from  an  ounce  to  one  and  a  half  ounces  in  its  healthy  con- 
dition. 

The  fundus  or  base  is  the  upper  broad  extremity  of  the 
organ  (a);  it  is  convex,  covered  by  peritoneum,  and  placed  on 
a  line  below  the  level  of  the  brim  of  the  pelvis. 

The  body  (6)  gradually  narrows  from  the  fundus  to  the 
neck.  Its  anterior  surface  is  flattened,  covered  by  peritoneum 
in  the  upper  three-fourths  of  its  extent,  and  separated  from 
the  bladder  by  some  coils  of  the  small  intestines;  the  lower 
fourth  is  connected  with  the  bladder. 

The  posterior  surface  of  the  body  is  convex,  covered  by 
peritoneum  throughout,  and  separated  from  the  rectum  by 
some  convolutions  of  the  intestines. 

Its  lateral  margins  are  concave  and  give  attachment  to 
the  Fallopian  tubes  (n),  above. 


124  HOME    TREATMENT. 

The  round  ligaments  (i)  are  attached  below  and  in  front  of 
these,  while  the  ligaments  of  the  ovaries  (o)  are  attached  be- 
hind and  below  these  structures. 

The  cervix  or  neck  of  the  womb  (c  d  e)  is  the  lower 
rounded  and  constricted  portion  of  the  uterus;  around  its 
circumference  is  attached  the  upper  end  of  the  vagina,  which 
extends  upwards  a  greater  distance  behind  than  in  front. 

At  the  vaginal  extremity  of  the  uterus  is,  in  the  virgin 
womb,  a  round,  but  after  childbirth  a  transverse  aperture, 
the  os  uteri  or  mouth  of  the  womb,  bounded  by  two  lips,  the 
anterior  of  which  is  thick,  the  posterior  narrow  and  long. 

THE    FALLOPIAN     TUBES. 

The  Fallopian  tubes,  or  oviducts  (n)  convey  the  ova  from 
the  ovaries  to  the  cavity  of  the  uterus.  They  are  two  in 
number,  one  on  each  side,  situated  in  the  free  margin  of  the 
broad  ligament,  extending  from  each  superior  angle  of  the 
uterus  to  the  ovaries.  Each  tube  is  about  four  inches  in 
length;  its  canal  is  exceedingly  minute,  and  commences  at 
the  superior  angle  of  the  womb  by  a  minute  orifice,  the  os- 
tium internum,  or  internal  mouth,  which  will  hardly  admit  a 
fine  bristle;  it  continues  narrow  along  the  inner  half  of  the 
tube,  and  then  gradually  widens  into  a  trumpet-shaped  ex- 
tremity, which  becomes  contracted  at  its  termination.  This 
opening  is  called  the  ostium  abdominale,  or  abdominal  mouth, 
because  it  communicates  freely  with  the  abdominal  cavity. 
The  margins  of  this  extremity  are  surrounded  by  a  series  of 
fringe-like  processes,  termed  fimbrise,  and  one  of  these  proc- 
esses is  connected  with  the  outer  end  of  the  ovary.  This 
part  of  the  Fallopian  tube  is  called  the  fimbriated  or  fringed 
extremity  (m). 

THE    OVARIES. 

The  ovaries  are  analogous  to  the  testes  in  the  male.  They 
are  two  oblong  flattened  and  oval  bodies,  situated  one  on 
each  side  of  the  uterus,  in  the  posterior  part  of  the  broad 
ligament  behind  and  below  the  Fallopian  tubes.     Each  ovary 


ANATOMY  OF  THE  FEMALE  ORGANS.         125 

is  connected,  by  its  anterior  margin,  to  the  broad  ligament, 
by  its  inner  extremity  to  the  uterus  by  a  proper  ligament 
of  the  ovary,  and  by  its  outer  end  to  the  fimbriated  ex- 
tremity of  the  Fallopian  tube  by  a  short  ligamentous  cord. 
The  ovaries  are  of  a  whitish  color,  and  present  either  a 
smooth  or  a  puckered  uneven  surface.  They  are  each  about 
an  inch  and  a  half  in  length,  three-quarters  of  an  inch  in 
width,  and  about  a  third  of  an  inch  thick,  and  weigh  from 
one  to  two  drams. 


CHAPTER  IX. 

MENSTRUATION  AND  MENSTRUAL  DISORDERS. 

The  first  appearance  of  the  menses  marks  an  epoch  in 
the  life  of  the  girl  which  ushers  in  womanhood.  It  is  the 
harbinger  of  the  fruitfulness  of  the  maiden,  whose  limbs 
now  become  rounder,  and  her  hips  widen  out,  while  the 
breasts  increase  in  size  and  the  entire  aspect  undergoes  pe- 
culiar changes,  which  all  point  to  the  approaching  condi- 
tion of  maturity. 

The  term  is  derived  from  the  Latin  plural  menses,  meaning 
month,  from  moon,  and  it  is  an  actual  fact  that  the  lunar 
forces  seem  to  influence  this  physiological  function,  inas- 
much as  it  recurs  every  four  weeks;  most  women  menstru- 
ate during  the  first  quarter,  and  only  a  very  few  during  the 
new  or  full  moon. 

During  infancy  and  childhood,  the  sexual  system  of  the 
female  is  inactive.  The  menstruation  begins,  in  a  temperate 
climate,  about  the  fourteenth  or  fifteenth  year  of  life,  and 
ceases  at  the  age  of  forty -five  or  a  little  later. 

The  climate  exerts  a  marked  influence  in  determinating 
the  first  appearance  of  menstruation,  which  is  further  in- 
fluenced by  the  conditions  of  life  and  society  in  which  the 
child  is  brought  up. 

The  diversity  in  the  ages  at  which  children  menstruate 
in  different  countries  cannot  be  laid  to  any  constitutional  pe- 
culiarities of  the  races.  Observation  has  established  that, 
when  children  of  the  same  race  and  family  are  brought 
from  a  hot  to  a  colder  climate,  the  advent  of  the  first 
menstruation  changes.  These  girls  menstruate  not  so 
young  as  their  older  sisters,  but  begin  about  at  the  same 
age  as  those  who  are  born  in  the  colder  climate. 

(126) 


MENSTRUATION   AND   MENSTRUAL   DISORDERS.  127 

In  hot  countries,  for  instance  in  Africa,  the  negroes  and 
girls  in  East  India  begin  to  have  their  periods  at  the  age  of 
ten  to  twelve  years.  In  Sweden  and  Norway  the  average 
age  for  the  first  menstruation  is  sixteen,  while  further  north, 
in  Lapland,  the  ages  vary  from  eighteen  to  twenty  years. 
Next  in  order  of  importance,  influencing  the  menstrual 
epoch,  are  the  surroundings  and  food. 

In  the  same  climate  there  are  differences  in  the  ages  of 
children  that  are  entirely  due  to  these  causes.  Children 
who  are  pampered  and  who  are  nurtured  in  ease  and  luxury 
menstruate  earlier  than  those  of  the  poor  or  even  of  the 
middle  class,  wTho  are  brought  up  in  habits  of  industry. 

We  observe  again  a  difference  in  the  ages  between  those 
who  are  reared  in  the  country  or  rural  districts  and  the 
dwellers  in  the  cities,  whether  it  be  in  luxurious  apartments 
or  in  tenement  houses.  The  former  grow  older  and  stronger 
than  the  latter  before  the  show  begins. 

The  temperament  also  greatly  influences  the  development 
of  the  function ;  children  who  are  nervous,  irritable,  and  of 
a  sanguineous  temperament,  menstruate  earlier  than  those  of 
sedate  habits. 

The  color  of  the  hair  and  complexion  are  also  indices  of 
the  respective  appearance  of  the  menses  in  the  brunette  and 
blonde.  It  has  been  observed  that  the  dark-complexioned 
girls  menstruate  sooner  under  similar  conditions  than  the 
blondes.  Weakly  children,  who  are  delicate  from  some  con- 
stitutional habit,  or  whose  organism  has  suffered  from  dis- 
turbances of  indigestion  or  suffered  severely  from  teething 
in  early  childhood,  menstruate  earlier  than  their  stronger 
and  robust  sisters. 

The  quantity  of  the  natural  menstrual  discharge,  as  well 
as  the  time  or  duration,  varies  greatly  in  health  with  differ- 
ent individuals.  We  first  notice  a  slimy  discharge,  which 
soon  becomes  tinged  with  blood,  and  after  one  or  two  days 
it  is  almost  of  pure  blood.  The  flow  generally  lasts  three  or 
four  days,  very  seldom  only  one  day,  and  sometimes  a  week 
to  ten  days. 


128  HOME   TREATMENT. 

The  monthly  recurrence  of  the  menstrual  periods  averages 
thirty  }^ears;  intemperate  climates  it  may  overreach  this  fig- 
ure a  little,  while  in  hot  climates  it  comes  much  below  this 
average. 

It  does  not  follow  as  a  rule  that  because  a  woman  began 
to  menstruate  quite  young,  the  change  of  life  will  take  place 
earlier.  This  also  depends  much  upon  temperament,  habit 
and  mode  of  life. 

Physiologists  have  established,  by  carefully-prepared  sta- 
tistics, that  the  average  period  of  menstruation  for  women 
who  began  to  menstruate  early  is  thirty-three  years,  while 
those  who  commenced  late  have  an  average  of  only  twenty- 
seven  years. 

When  a  woman  is  forty-five  years  of  age,  we  may,  how- 
ever, as  a  rule,  look  for  the  change  of  life  to  set  in ;  if  she  goes 
beyond  this  age,  she  may  be  taken  as  the  exception. 

The  cavity  of  the  womb  is  the  principal  source  from 
which  the  blood  comes;  while  the  ovaries  and  tubes  are  also 
greatly  congested  with  blood,  the  amount  that  comes  from 
them  must  be  very  small. 

The  blood  that  comes  from  the  womb  is  not  different 
from  blood  coming  from  any  other  source;  the  changes  and 
peculiarity  of  the  menstrual  show  are  due  to  its  passage 
through  the  vagina,  where  it  becomes  contaminated  with 
vaginal  secretions. 

It  is  supplied  from  the  blood-vessels  of  the  womb,  oozing 
through  the  mucous  membrane  of  that  organ,  just  as  in  a 
case  of  nosebleed.  The  entire  womb  is  more  or  less  swollen, 
and  more  especially  the  mucous  lining,  so  that  it  corre- 
sponds, in  many  instances,  to  an  inflammatory  process,  and 
for  that  very  reason,  a  sudden  check  of  the  menstrual  flow 
will  often  result  in  a  regular  subacute  or  acute  inflam- 
mation of  the  womb.  If  the  discharge  of  blood  from  the 
uterus  is  in  small  quantities  and  a  gradual,  steady  flow,  it 
becomes  so  altered  by  the  secretions  in  its  passage  through 
the  vagina  that  it  does  not  coagulate,  but  when  it  is  poured 


MENSTRUATION   AND   MENSTRUAL   DISORDERS.  129 

out  more  rapidly  or  in  larger  quantities,  the  menstrual 
blood  coagulates  or  congeals  in  the  same  manner  as  if  it 
were  derived  from  other  sources. 

If  a  woman  becomes  pregnant,  the  menses  as  a  rule  are 
suspended  during  the  child-bearing  period,  and  usually  re- 
main absent  after  the  child  is  born  so  long  as  the  woman 
nurses  the  child.  I  have  known  one  woman  who  menstru- 
ated during  her  entire  pregnancy,  and  another  who  had 
had  eight  children  and  never  menstruated  in  her  life,  yet 
she  was,  and  always  had  been,  in  perfectly  good  health : 
thus  we  see,  that  there  is  no  rule  without  exceptions. 

An  essential  part  of  the  menstrual  function  is  that  in 
which  the  ova  or  female  germ  cells  ripen  and  are  expelled 
from  the  ovary.  The  menstruation  is  only  a  reflex  or  side 
issue,  to  a  more  important  part  that  is  going  on  in  the  fe- 
male generative  system;  this  is  termed  ovulation,  or  the  rip- 
ening and  expulsion  of  the  human  egg  from  the  tissues  of 
the  ovaries.  In  the  physiological  process  that  operates  in  the 
economy  of  nature  for  reproduction,  the  ovaries  are  the  prin- 
cipal organs.  The  other  organs  are  simply  accessory,  and 
indeed  many  of  the  lower  animals  have  no  other  organs 
than  the  ovaries  for  the  perpetuation  of  their  species. 

In  the  human  female,  the  ovaries  consist  of  a  tough  fi- 
brous tissue,  between  whose  meshes  are  little  cysts,  which 
are  called  Graafian  vesicles,  and  these  little  vesicles  serve  as 
the  nests  in  which   the   ova  or  little  germ  cells   mature. 

These  ova  which  are  imbedded  in  the  Graafian  vesicles 
are  so  small  that  they  can  only  be  seen  by  a  high  magnify- 
ing power. 

The  activity  of  the  ovaries  begins  at  puberty,  and  ceases 
with  the  change  of  life,  or  menopause. 

The  approach  of  the  menses  is  signalized  by  a  certain 
group  of  symptoms,  which  clearly  indicate  a  congestion  of 
the  pelvic  organs. 

There  is  generally  a  drawing  sensation  in  the  back  and 
thighs,  and  a  sensitiveness  upon  pressure  in  the  regions  of 
9 


130  HOME    TREATMENT. 

the  ovaries  and  the  womb.  There  is  a  feeling  of  lassitude 
and  weakness  of  the  limbs,  sometimes  hot  flushes  changing 
off  with  chills,  and  often  a  feverish  condition,  which  will 
last  until  the  flow  is  fully  established. 

Professor  Dalton  says :  "  In  many  birds,  for  example,  the 
plumage  assumes  at  this  period  more  varied  and  brilliant 
colors ;  and  in  the  common  fowl  the  comb  or  '  crest '  en- 
larges, and  becomes  red  vascular.  In  the  American  deer, 
the  coat  which,  during  the  first  year  is  mottled  with  white, 
becomes  in  the  second  year  of  a  uniform  tawny  or  reddish 
tinge.  In  nearly  all  species,  the  limbs  become  more  com- 
pact and  the  body  more  rounded ;  and  the  whole  external 
appearance  is  so  altered,  as  to  indicate,  that  the  animal  has 
arrived  at  the  period  of  puberty,  and  is  capable  for  repro- 
duction." 

In  the  human  subject,  the  child  now  becomes  conscious 
of  the  sexual  instinct,  however  chaste  or  virtuous  her  mind, 
for  we  must  not  dull  our  intelligence  with  the  idea  that  the 
sexual  function  is  unholy ;  it  is  no  more  so  than  to  say  our 
prayers ;  so  that  an  additional  duty  is  now  incumbent  upon 
mother  or  guardian. 

The  child  must  be  made  to  know  that  she  must  be  more 
reserved  and  guarded  in  her  relations  with  the  male  sex; 
that  she  no  longer  can  romp  or  play  on  the  knees  of  male 
friends  or  visitors,  and  that  it  is  dangerous  and  unbecoming 
to  be  left  alone  with  them.  A  little  later  on,  she  must  be 
apprised  that  she  too  may  become  a  mother,  and  that  that 
would  be  a  great  disgrace  for  one  so  young  and  not  married. 
The  child  thus  learns  to  protect  herself  against  the  insid- 
ious smiles  and  snares  of  the  seducer,  for  he  is  ever  abroad, 
and  often  family  friend  and  trusted  adviser. 

There  are  beings  who  are  men  in  form  only,  but  at 
heart  are  black  villains,  and  selfish  brutes.  When  the  mis- 
chief is  done,  then  it  is  too  late  to  repent  of  a  mother's  neg- 
ligence, or  to  bewail  a  child's  disgrace  and  man's  perfidy ; 
the  three  combined  make  one  of  the  most  distressing  scenes 
that  it  has  ever  been  my  misfortune  to  behold. 


MENSTRUATION   AND   MENSTRUAL   DISORDERS.  131 

Successive  crops  of  eggs  ripen,  and  are  discharged  by  the 
adult  female  at  each  menstrual  period. 

I  have  already  said  that  the  ovum  is  contained  in  the 
Graafian  vesicle,  in  which  it  grows  and  matures,  as  the  fruit 
ripens  on  a  tree,  so  the  Graafian  vesicle  gradually  ripens 
for  the  expulsion  of  the  ovum,  which  gradually  makes  its 
way  to  the  surface  of  the  ovary.  Within  the  Graafian 
vesicle  the  serous  fluid  accumulates,  so  that  it  ruptures  and 
■discharges  its  little  ovum,  which  is  taken  up  by  the  fringed 
extremity  of  the  Fallopian  tube,  and  carried  along  the  ovi- 
duct into  the  womb,  from  which  it  escapes  into  the  vagina, 
.and  is  lost,  provided  conception  has  not  taken  place. 

Investigations  have  been  made  as  to  the  number  of  ova 
certain  mammalia  discharge,  and  it  has  been  found  to  cor- 
respond with  the  number  of  young  that  the  animal  pro- 
duces at  birth.  Where  a  litter  consists  of  from  three  to 
twenty,  as  in  the  bitch  and  the  sow,  a  similar  number  of 
€ggs  ripen,  and  are  discharged  at  the  period  of  cestruation. 

In  the  cow  or  mare,  and  in  the  human  female,  as  a  rule, 
only  one  egg  is  discharged  at  each  period  of  ovulation. 

The  discharge  of  ripened  ova  does,  however,  occur  in  ex- 
ceptional cases  without  any  sign  of  the  menstrual  show,  and 
the  person  may  be  susceptible  to  conception,  so  that  we  may 
reasonably  infer,  that  ovulation  constitutes  the  most  impor- 
tant function  of  the  menstrual  period. 

MENSTRUAL   DISORDERS. 

These  are  designated  by  different  terms,  not  because  each 
name  signifies  a  particular  disease,  but  simply  an  indefinite 
symptom  of  a  diseased  condition.  In  other  cases  menstrual 
disorder  may  produce  symptoms  that  are  common  to  widely 
■different  diseases.  In  other  words,  the  phrase  menstrual 
disorder,  without  being  qualified  as  to  its  particular  cause, 
means,  from  a  practical  standpoint  nothing  upon  which  a 
treatment  can  be  intelligently  based.  Not  any  more  than  a 
cough  which  is  simply  an  irritation  of  the  bronchical  nerves, 


132  HOME    TREATMENT. 

and  may  be  due  to  a  bronchitis  or  pneumonia,  or  it  may 
not  be  due  to  any  pulmonary  affection  at  all,  as,  for  instance,, 
in  the  case  where  an  aneurismal  tumor  presses  on  the  bron- 
chial nerves,  and  excites  severe  paroxysms  of  coughing.  A 
great  many  menstrual  disorders  are  due,  not  to  any  disease 
of  the  generative  organs,  but  to  an  affection  of  the  nervous 
system. 

Menstruation  may  be  precocious  in  some  girls,  and  if 
the  discharge  is  not  accompanied  with  the  usual  symptoms 
of  backache  and  some  of  the  other  symptoms  that  charac- 
terize the  normal  appearance  of  the  menses,  or  if  the  girl 
is  otherwise  not  fully  developed,  and  has  in  this  climate  not 
reached  her  twelfth  or  fourteenth  year,  it  constitutes  a  sign 
of  a  disease.  If,  however,  the  show  recurs  at  certain  inter- 
vals, it  is  not  to  be  considered  with  the  same  degree  of 
apprehension  that  it  would  be  if  it  recurred  at  irregular 
intervals. 

The  sanguineous  discharge  which  shows  itself  at  the 
genitals  during  an  acute  attack  of  an  infectious  disease,  has 
no  relation  whatever  with  the  menstrual  function;  this  may 
take  place  in  children  at  any  early  age. 

We  often  see  girls  who  are  not  yet  thirteen,  who  still  wear 
short  clothes  and  go  to  school,  that  menstruate  regularly, 
but  with  this  precocious  menstruation  there  is  also  a  corre- 
sponding development  of  the  body  which  gives  them  a 
womanly  appearance.  Such  girls  should  not  be  permitted  to 
expose  themselves  to  the  inclemency  of  the  weather,  because 
they  are  much  more  liable  to  take  cold,  which  may  result 
in  inflammations,  than  girls  in  whom  the  menses  have  not 
appeared. 

Girls  of  a  scrofulous  taint  or  other  hereditary  habits  of 
constitution,  often  begin  to  menstruate  prematurely;  out- 
door exercise  and  cod  liver  oil  with  cold  sponging  on  retiring 
at  night  are  the  proper  resources  for  building  them  up. 

AMEN0RRHCEA. 

This  term  is  employed  for  the  purpose  of  designating  an 


MENSTRUATION    AND    MENSTRUAL    DISORDERS.  133 

absence  of  the  menstrual  flow  in  persons  who  are  old  enough 
to  menstruate,  and  in  whom  there  is  no  physiological  reason 
for  its  suppression,  such  as  being  too  young,  after  the 
change  of  life,  or  during  j.regnancy  and  while  nursing  the 
child  on  the  breasts. 

We  find  this  disorder  of  the  natural  function  of  men- 
struation more  among  the  women  of  the  rich  and  affluent 
whose  lives  are  spent  in  indolence  and  luxury;  this  is  to  be 
ascribed  to  lack  of  sufficient  exercise  to  stimulate  the  nervous 
and  sanguineous  systems  to  the  performance  of  their  healthy 
functions. 

The  amenorrhcea,  or  a  retarded  menstruation  in  young 
girls,  is  oftener  the  result  of  a  general  debility  than  of  a  dis- 
ease of  either  the  womb  or  ovaries.  We  have  here  again 
about  the  same  causes  playing  their  pernicious  role  as  in 
precocious  menstruation  in  weakly  children;  that  is,  that  the 
same  causes  produce  directly  opposite  results.  The  scrofu- 
lous and  hereditary  taints  always  interfere  with  the  proper 
and  healthy  development  of  the  system;  in  amenorrhcea 
they  appear  to  be  a  hindrance  to  the  formation  and  growth 
of  the  red  blood  corpuscles.  In  some  girls  the  suppression 
of  the  courses  appears  to  be  a  wise  conservative  provision  of 
nature,  because  the  girls  are  already  so  weak  and  bloodless 
that  even  the  loss  of  a  very  small  amount  would  only  in- 
crease the  anaemia,  so  that  in  these  cases  it  is  not  so  much  a 
question  of  "  bringing  on  the  courses  "  as  of  building  up  the 
constitution,  and  enriching  the  blood  in  order  to  bring  about 
the  desired  result. 

Chlorosis,  or  the  green  sickness,  is  not  simply  an  anae- 
mia or  a  bloodlessness,  but  a  physiological  incapacity  of 
the  system  to  prepare  the  required  blood  cells  for  the  san- 
guineous fluid,  and  this  is,  indeed,  the  most  frequent  cause 
of  the  disorder  under  consideration.  Chlorosis  is  a  disease 
that  is  peculiar  to  the  female  sex,  beginning  as  a  rule  at  the 
age  of  approaching  puberty,  between  the  fourteenth  and 
twentieth  year,  so  that  there  appears  to  be  a  physiological 


134  HOME   TREATMENT. 

relation  between  the  blood  genesis  on  the  one  hand,  and 
the  development  of  womanhood  on  the  other. 

In  some  cases  we  can  trace  the  impoverished  condition  of 
the  blood  to  unhealthy  dwellings,  impure  air,  want  of  exer- 
cise, improper  diet,  nervousness,  the  reading  of  exciting,  am- 
orous novels,  and  the  practice  of  masturbation  or  self-abuse. 
On  the  contrary,  the  disease  is  often  developed  under  the 
most  moral  and  exacting  discipline  and  hygienic  surround- 
ings. 

I  have  known  girls  who  lived  in  the  country,  enjoyed 
horseback  riding,  ate  nutritious  and  wholesome  food,  and 
whose  solitary  moments  were  beyond  suspicion,  yet  at  the 
age  of  puberty  they  commenced  to  fade  in  color,  and  fail  in 
strength,  gradually  growing  paler  and  weaker,  until  they  be- 
came chlorotic  and  bloodless.  This  can  only  be  explained 
on  the  theory  that  the  period  in  which  nature  was  preparing 
the  system  for  the  purposes  she  had  in  view,  caused  a  shock 
to  the  nervous  system,  which  so  disarranged  the  functions 
that  the  sanguineous  system  did  not  respond  to  the  growth 
of  the  generative  system. 

Then  there  is  another  class  of  cases,  where  girls  men- 
struate before  they  are  old  enough,  and  without  their  bodies 
showing  any  visible  evidence  of  developed  womanhood,  who 
belong  to  the  most  obstinate  cases  for  successful  treatment. 

The  relative  diminution  of  the  red  blood  cells  to  the 
healthy  standard  is  in  some  cases  truly  alarming.  In  the 
average  healthy  blood,  there  are,  in  one  thousand  parts  of 
blood,  one  hundred  and  thirty  parts  of  red  blood  cells;  this 
falls  to  sixty,  and  even  forty  parts  in  the  thousand  in  the 
chlorotic  patient. 

It  is  one  of  the  peculiarities  of  this  disease,  that  while 
the  muscular  tissue  wastes  away,  the  fatty  tissue  is  not  only 
preserved,  but  it  sometime  increases,  so  that  in  a  family  of 
several  girls,  the  chlorotic  girl  is  considered  the  'most  fleshy,' 
but  as  fat  is  not  flesh,  the  appearance  is  deceptive. 

When  we  stop  to  think  a  moment,  that  the  red  blood  cor- 


MENSTRUATION   AND   MENSTRUAL   DISORDERS.  135 

pusclcs  are  the  messengers  which  absorb  the  oxygen  in  the 
lungs  during  the  respiratory  movements,  and  carry  it  to 
the  different  organs  and  tissues  of  the  body,  without  which 
all  tissue  change  would  cease.  And  that  the  same  red  blood 
cells  must  return  again  to  the  lungs  for  exhaling  the  car- 
bonic acid,  one  of  the  waste  products  of  tissue  growth,  then 
the  diminution  of  the  red  blood  cells  in  the  proportion  above 
given,  must  affect  the  entire  system  very  injuriously. 

This  is  indeed  the  case;  the  natural  respiratory  move- 
ments are  insufficient  on  the  slightest  exertion,  so  that 
patients  tell  us  that  when  they  walk  a  little  fast,  go  up 
the  stairs,  or  even  sweep  the  room,  they  feel  a  shortness  of 
breath. 

There  are  other  symptoms  that  point  to  carbonic  acid 
poisoning,  which  it  will  be  interesting  to  review.  A  great 
majority  of  these  symptoms  are  to  be  found  in  every  case  of 
chlorosis.  The  muscles  become  weak  at  first,  because  their 
nutrition  is  interfered  with,  and  they  waste  away,  and  sec- 
ondly they  become  irritable  from  the  poisonous  presence  of 
the  carbonic  acid,  and  so  are  often  very  painful.  The  patients 
are  easily  tired  out;  some,  indeed,  feel  tired  all  the  time,  get- 
ting up  in  the  morning  as  worn  out  as  when  they  retired  at 
night. 

The  nervous  system  suffers  as  much,  because  the  princi- 
pal nerve  food  is  oxygen,  and  if  there  is  no  blood,  there  can 
be  no  oxygen ;  a  starved  nerve  is  a  painful  nerve.  We  find 
neuralgias,  affecting  the  different  parts  of  the  body,  the  rule; 
when  these  are  located  in  the  external  muscles,  they  are 
easily  recognized,  but  when  located  in  the  deep  organs,  as 
the  ovaries  or  the  womb,  they  are  generally  mistaken  for 
something  else.  The  nerves  of  these  individuals  being  in 
such  an  irritable  state,  it  is  natural  to  infer,  that  hysteria  is 
often  to  be  found  as  one  of  the  complications,  so  that  habit- 
ual sadness,  and  abnormal  longings  after  chalk,  lead  pencils, 
and  other  indigestible  articles  are  prominent  symptoms. 

The  circulatory  system  suffers  derangements  that  are 


136  HOME   TREATMENT. 

characteristic  of  chlorosis.  Palpitation  of  the  heart  is  a 
prominent  symptom ;  this  is  partly  due  to  the  irritation  of 
the  carbonic  acid  on  the  cardiac  nerves,  and  partly  to  sensi- 
tiveness of  the  patient,  owing  to  a  morbidly-increased  sensi- 
bility of  the  whole  body.  Chlorotic  patients  blush  up  at 
times,  only  to  be  followed  by  a  green  paleness  that  is  pecul- 
iar to  the  disease.  Pain  in  the  region  of  the  heart,  and  dis- 
turbances of  the  digestion,  are  sometimes  prominent  symp- 
toms. There  is  no  feeling  of  hunger ;  eating  is  not  so  much 
from  hunger,  but  more  from  a  sense  of  duty  to  keep  up  the 
strength.  A  heavy  or  full  feeling  is  often  experienced  after 
a  meal,  and  a  sourish  eructation  will  give  relief  to  the  op- 
pression, because  the  walls  of  the  stomach  are  relaxed  and 
in  sympathy  with  the  general  debility. 

But  in  all  cases  of  chlorosis  the  sexual  functions  are  the 
seat  of  the  greatest  disturbance ;  amenorrhea  or  the  sup- 
pression of  the  menses  is  the  most  prominent  symptom. 
The  ovaries  no  longer  seem  to  expel  ripened  ova,  for  there 
are  no  indications  that  point  to  their  activity,  because  there 
is  not  only  an  absence  of  the  show,  but  also  an  absence  of 
the  other  signs  that  were  noted  when  we  considered  menstru- 
ation and  ovulation. 

There  are  a  great  many  other  diseases  of  which  amen- 
orrhcea  is  a  prominent  symptom ;  these  will  be  referred  to 
when  separate  diseases  become  the  subject  of  special  inquiry. 

The  treatment  of  amenorrhcea  is,  indeed,  in  the  great 
majority  of  cases,  the  treatment  of  chlorosis,  and  that  should 
be  conducted  on  common-sense  principles.  If  the  child  has 
vicious  practices,  they  must  be  corrected,  and  everything  else 
that  has  been  mentioned  as  a  cause  must  be  abandoned. 
Children  who  were  once  robust  and  strong  require  electrical 
treatment,  while  those  who  were  naturally  weak  require 
nourishing  food  and  tonics.  If  there  is  in  the  entire  phar- 
macopcea  a  remedy  that  deserves  the  name  of  a  specific,  it  is 
to  that  one  which  I  suggest  in  amenorrhcea  due  to  chlorosis 
or  anaemia.     Iron   preparations  are  very  numerous;  every 


MENSTRUATION   AND   MENSTRUAL    DISORDERS.  137 

physician  has  his  favorite  prescription;  some  are  to  be  praised 
more  for  their  elegance  and  flavor  than  for  any  virtue  that 
they  possess.  If  in  these  cases  any  positive  and  decided  re- 
sult is  to  follow  the  administration  of  iron,  it  must  be  given 
in  such  a  mild  form  that  it  can  be  taken  in  great  quan- 
tities without  irritating  the  stomach  or  interfering  with  di- 
gestion. If  the  contents  of  the  wThole  alimentary  canal 
are  saturated  or  impregnated  with  the  ferruginous  medicine, 
there  will  be  astonishing  curative  effects. 

I  have  often  observed  chlorotic  cases  who  have  made 
the  rounds  of  the  different  iron  springs,  and  who  have  taken 
the  numerous  and  various  fancy  elixirs,  without  the  slightest 
perceptible  effect,  bloom  up,  after  being  fed,  so  to  speak,  on 
some  harmless  iron  preparation,  which  was  astonishing 
to  themselves  and  surprising  to  their  friends.  The  follow- 
ing is  my  favorite  prescription  for  chlorosis  or  anaemia : 

no.  I. 

Take:  Powd.  Carb.  of  iron,  sacch.  (Germ.) 1  ounce 

Powd.  Aloes 20  grains 

Powd.  Tragacanth 20  grains 

Mix  with  sufficient  water  to  make  into  a  hard  mass  and 
divide  into  one  hundred  and  fifty  pills,  and  roll  in  pow- 
dered cinnamon. 

Take  three  pills  three  times  a  day  and  after  three  days 
increase  to  four  pills  at  one  dose  three  times  a  day,  then 
after  another  three  days  increase  to  five  pills  as  many  times 
a  day  as  before;  if  these  doses  are  not  at  first  borne,  begin 
with  less,  and  if  there  is  no  costiveness  or  tendency  thereto, 
omit  the  aloes. 

If  there  is  reason  to  believe  that  the  impoverishment  of 
the  blood  is  partly  or  wholly  due  to  scorfulous  taints,  then  it 
is  advisable  to  take  fresh,  pure  cod  liver  oil  in  conjunction 
with  the  iron  pills;  three  boxes  of  pills  are,  as  a  rule, 
necessary  to  effect  a  cure. 

It  happens  quite  often  in  chlorosis  or  anaemia  that  there 
is  a  distressing  dyspepsia  or  indigestion  with  loss  of  appetite. 


138  HOME   TREATMENT 

In  these  cases  I  would  first  advise  to  put  the  stomach  in 
order;  this  is  done  by  first  avoiding  all  indigestible  food, 
such  as  cakes,  pies,  and  puddings,  and  taking  the  following 
medicine : 

NO.  II. 

Take :  Bicarbonate  of  soda 2  drams 

Subcarbonate  of  bismuth 2  drams 

Tr.  of  nux  vom 2  drams 

Fluid  ex.  of  rhubarb 3  drams 

Simple  syrup 1   ounce 

Peppermint  water  sufficient  to  make,  8  ounces 

Take  a  tablespoonful  three  times  a  day,  and  if  the  bowels 
move  freely  take  less. 

Hygiene  in  the  treatment  of  every  disease  is  to  be  an 
important  factor ;  all  vicious  habits  must  be  abandoned. 

DYSMENORRHEA. 

Difficult  or  painful  menstruation  is  the  definition  of  the 
above  word;  all  painful  menstrual  disorders  that  take  place 
either  before  or  during  the  menstrual  flow  come  under  this 
designation. 

The  seat  of  the  pain,  when  of  a  colicky  nature,  is  in  the 
uterus;  when  a  continuously  dull  ache  is  in  the  small  of  the 
back,  it  is  located  in  the  nervous  plexus  in  the  small  of  the 
back.  The  pain  is  very  often  in  the  ovaries  and  in  that 
portion  of  the  peritoneal  membrane  which  folds  over  all  the 
pelvic  organs  and  extends  on  the  sides  of  the  womb,  consti- 
tuting the  broad  ligaments;  when  the  pain  is  confined  to 
these  structures,  it  is  principally  felt  below  the  stomach  and 
over  the  lower  part  of  the  bowels. 

Painful  menstruation  is  a  prominent  symptom  of  a  great 
many  diseases,  and  it  often  strains  the  ingenuity  of  the  most 
clever  specialist  to  trace  the  symptoms  to  their  real  cause. 

Obstructive  dysmenorrhea,  as  its  name  implies,  is  due 
to  some  hindrance  or  obstacle  to  the  escape  of  blood  from 
the  cavity  of  the  womb.  The  obstruction  may  exist  in  the 
neck  of  the  womb,  at  its  mouth,  or  in  the  vagina.     When  the 


MENSTRUATION    AND    MENSTRUAL    DISORDERS.  139 

obstruction  is  in  the  neck  of  the  womb,  it  may  be  congenital 
or  date  from  birth.  The  constriction  or  narrowness  may  be 
due  to  an  acquired  inflammation  of  the  lining  membrane  of 
the  neck  of  the  womb.  Every  inflammation  causes  a  swell- 
ing of  the  tissues,  and  if  the  inflammation  continues,  the 
swelling  becomes  permanent  and  a  stricture  is  the  result. 

Sucli  strictures  are  often  the  result  of  the  applications  of 
strong  caustics  and  meddlesome  tampering  by  the  ignorant 
specialist  and  abortionist.  The  application  of  the  electrical 
current  by  means  of  the  uterine  electrode  is  the  most  mod- 
ern and  effectual  method  of  treating  these  cases  successfully. 

Flexion  of  the  womb  is  understood  to  be  a  condition  in 
which  the  uterus  is  flexed  or  bent  upon  itself  at  a  sharp  angle, 
just  as  a  rubber  hose  that  is  bent  sharply  on  itself  becomes 
compressed  at  the  kink  so  as  to  shut  off  the  flow,  in  this  man- 
ner the  flow  of  blood  from  the  cavity  of  the  womb  is  partly 
shut  off,  and  the  obstruction  is  the  cause  of  the  painful 
menstruation. 

In  some  women  who  have  flexion  or  a  bent  womb  there 
is  no  obstruction,  because  the  probe  passes  the  canal  freely; 
in  these  cases  dysmenorrhcea  must  be  traced  to  some  other 
cause.  If  it  is  clearly  established  that  flexion  is  the  cause 
of  the  obstruction,  the  most  successful  treatment  is  the  elec- 
trical current.  I  have  often  had  cases  where  little  mucous 
growths  no  larger  than  a  small  marble,  grew  in  the  canal 
and  obstructed  the  free  escape  of  blood ;  after  these  were 
removed,  the  dysmenorrhcea  ceased  at  once. 

Other  obstructions  may  be  due  to  a  stricture  of  the  vagina 
or  some  deformity  of  the  hymen  ;  a  very  slight  surgical  op- 
eration will  permanently  relieve  both  of  these  hindrances. 

There  is  a  much  larger  proportion  of  cases  that  suffer 
from  painful  menstruation  in  whom  the  uterine  organs  are 
perfectly  healthy,  but  who  are  systematically  injured  by  dis- 
honest or  hungry  specialists,  by  being  subjected  to  local  treat- 
ments. I  have  had  cases  of  this  nature  fall  into  my  hands 
very  often.     They  had  made  the  rounds  of  the  specialists 


140  HOME   TREATMENT. 

and  had  been  made  the  innocent  prey  of  avaricious  pro- 
fessional competition,  so  that  it  is  of  the  greatest  impor- 
tance to  distinguish  this  class  of  cases  from  those  in  which 
the  pelvic  organs  are  the  seat  of  the  difficulty. 

Nervous  and  congestive  dysmenorrhoeas  are  particularly 
adapted  for  the  hygiene  of  home  treatment.  Nervous  or  neu- 
ralgic dysmenorrhea  is  very  often  overlooked,  and  treated 
as  a  local  lesion  of  the  womb. 

The  psychical  exaggeration  which  many  women  experi- 
ence at  the  approach  of  the  menses  is  abnormally  height- 
ened in  dysmenorrhea.  The  pains  in  the  back,  in  the  hips, 
and  in  the  lower  part  of  the  abdomen  disturb  the  normal 
operations  of  the  mind.  The  irritation  of  the  nerves  of  the 
womb  is  often  reflected  to  distant  organs,  and  pain  is  felt 
in  remote  regions.  Some  women  suffer  only  just  a  day  or 
two  preceding  the  flow,  while  others  suffer  severely  during 
the  entire  period,  so  that  they  are  forced  to  keep  to  their 
bed  the  greater  part  of  the  time. 

Professor  William  Goodell,  one  of  the  most  profound  and 
original  female  specialists  in  America,  has  this  to  say  in  a 
recent  publication:  "  I  have  learned  to  unlearn  the  idea — 
and  that  was  the  hardest  task  of  all — that  uterine  symptoms 
are  not  always  present  in  cases  of  uterine  disease ;  or  that, 
when  present,  they  necessarily  come  from  uterine  disease. 
The  nerves  are  mighty  mimers,  the  greatest  of  mimics,  and 
they  cheat  us  by  their  realistic  personations  of  organic  dis- 
ease and  especially  of  uterine  disease.  Hence  it  is  that  even 
seemingly  urgent  uterine  symptoms  may  be  merely  nerve 
counterfeits  of  uterine  disease.  I  have,  therefore,  long  since 
given  up  the  belief,  which,  with  many,  amounts  to  a  creed, 
that  the  womb  is  at  the  bottom  of  every  female  ailment. 

"Nerve  strain,  or  nerve  exhaustion,  comes  largely  from  the 
frets,  the  griefs,  the  worries,  the  carks  and  cares  of  life.  Yet 
although  the  imagination  undoubtedly  affects  it,  it  is  not  a 
mere  whim  or  imaginary  disease,  as  all  healthy  women  and 
physicians  think ;  but  it  is  the  veriest  of  realities.     When 


MENSTRUATION   AND   MENSTRUAL   DISORDERS.  141 

some  flippant  talker  or  some  slipshod  thinker  scoffs  at  nerv- 
ousness as  a  sham  disorder,  I  say  to  him :  '  Can  the  bribe 
of  a  principality  keep  you  from  blushing  when  you  are 
ashamed,  or  from  blanching  when  you  are  afraid  ? '  Under 
the  flitting  sense  of  shame  or  of  fear  these  vasomotor  dis- 
turbances are  momentarily  beyond  your  control ;  and  so 
they  are  in  the  nervous  woman,  whose  vital  organs  are,  as 
it  were — not  transiently  but — perpetually  blushing  and 
blanching  under  deficient  brain-control  over  the  lower  nerve 
centers. 

"  Strangely  enough,  the  most  common  symptoms  of  nerve 
disorder  in  women  are  the  very  ones  which  tradition  and 
dogmatic  empiricism  attribute  to  womb  disease. 

"  They  are,  in  the  order  of  their  frequency,  great  weari- 
ness and  more  or  less  of  wakefulness  and  inability  to 
walk  any  distance,  a  bearing-down  feeling,  headache,  nape- 
ache  and  back-ache,  scant,  or  painful,  or  delayed,  or  sup- 
pressed menstruation,  cold  feet,  and  irritable  bladder,  gen- 
eral spinal  and  pelvic  soreness,  and  pain  in  one  ovary, 
usually  the  left,  or  in  both  ovaries.  The  sense  of  exhaus- 
tion is  a  remarkable  one;  the  woman  is  always  tired,  she 
passes  the  day  tired,  and  she  goes  to  bed  tired,  and  she 
wakes  up  tired,  often,  indeed,  more  tired  than  when  she  fell 
asleep.  She  sighs  a  great  deal,  she  has  low  spirits,  and  her 
arms  and  legs  become  numb  so  frequently  that  she  fears 
palsy  or  paralysis. 

"  There  are  many  other  symptoms  of  nerve  strain,  but 
since  they  are  not  so  distinctly  uterine,  and,  therefore,  not  so 
misleading,  I  shall  not  enumerate  them.  Now,  let  a  nervous 
woman  with  some  of  the  foregoing  group  of  symptoms 
recount  them  to  a  female  friend,  and  she  will  be  told  that 
she  has  womb  disease.  Let  her  consult  a  physician  and  ten 
to  one  he  will  think  the  same  thing  and  diligently  hunt  for 
some  uterine  lesion.  If  one  be  found,  no  matter  how  tri- 
fling, he  will  attach  to  it  undue  importance,  and  treat  it 
heroically  as  the  offending  organ.     If  no  visible  disease  of 


142  HOME    TREATMENT. 

the  external  organs  be  discoverable,  he  will  lay  the  blame 
to  the  invisible  endometrium,  or  on  the  unseeable  ovaries, 
and  continue  the  local  treatment.  In  any  event,  whatever 
the  inlook  or  the  outlook,  a  local  treatment  is  bound  to  be 
the  issue." 

The  nervous  variety  of  painful  menstruation  is  fre- 
quently due  to  impoverishment  of  the  blood,  which,  as  we 
have  learned,  is  often  the  direct  cause  of  irritable  nerves. 
The  same  treatment  as  for  chlorosis  will  give  the  desired 
relief:  the  treatment  with  iron  pills.  If  the  stomach  is 
deranged  from  d}rspeptic  disorders,  then  my  dyspeptic  mix- 
ture, No.  II,  is  to  be  given.  But  there  are  cases  that  are 
purely  neuralgic  without  any  apparently  serious  lesion  of 
the  blood;  cases  in  which  the  neuralgia  of  the  womb  or 
ovaries  is  probably  due  to  exposure  to  cold  or  some  other 
indiscretion ;  here  the  following  recipe  will  effect  a  cure  in 
the  course  of  several  months: 

NO.  III. 

Take :  Fluid  ex.  of  black  cohosh J  ounce 

Fluid  ex.  of  ergot J  ounce 

Tr.  of  guaiacum  ammoniated 3  ounces 

Glycerine 2  ounces 

Mix.  Take  a  teaspoonful  in  a  tumblerful  of  milk  three 
times  a  day,  between  meals. 

Congestive  dysmenorrhcea  is  oftener  in  the  nature  of  an 
acute  or  sudden  attack,  except  when  it  is  due  to  a  chronic 
inflammation  of  the  lining  membrane  of  the  womb.  It  is 
often  brought  on  by  a  sudden  or  inadvertent  exposure,  just 
at  the  time  when  the  menses  should  make  their  regular  ap- 
pearance. 

Persons  of  a  plethoric  habit  and  those  who  have  been 
the  subjects  of  inflammations  either  of  the  womb  or  in  the 
tissues  surrounding  the  womb,  are  more  liable  to  this  form 
of  dysmenorrhea  than  others.  It  will  often  be  ushered 
in  with  a  chill,  followed  soon  with  fever.  There  is  head- 
ache, the  skin  becomes  dn^  and  hot,  and  often  there  is  con- 


MENSTRUATION   AND   MENSTRUAL    DISORDERS.  143 

siderable  irritability  of  the  bladder,  straining  of  the  rectum 
and  diarrhoea.  Unless  the  pain  is  due  to  an  obstinate  dis- 
placement, it  yields  to  proper  treatment.  For  the  straining 
and  irritable  bladder  a  hot  sitz-bath  should  be  employed 
for  ten  to  fifteen  minutes.  In  the  absence  of  a  suitable  ves- 
sel for  a  sitz-bath  an  ordinary  bathtub  can  be  used  by  filling 
it  six  or  eight  inches  with  water,  at  a  temperature  of  104° 
F.,  and  while  sitting  in  the  bath  allow  the  boiling  water 
to  run  slowly  into  it,  so  as  to  keep  the  temperature  up. 
These  sitz-baths  should  be  taken  several  times  a  day,  and 
after  each  bath  the  patient  should  rub  herself  thoroughly 
dry  and  wear  flannel  next  to  the  skin.  The  extremities 
and  feet  should  also  be  kept  warm  by  wearing  woolen  hose. 

Towels  wrung  out  of  hot  water  should  be  carefully 
folded  and  applied  to  the  lower  region  of  the  abdomen  and 
then  covered  over  with  a  thickly  folded  flannel  cloth  so  as 
to  retain  the  heat  and  moisture;  when  the  towel  has  cooled 
off  repeat  the  dipping  in  hot  water. 

The  Femina  vaginal  capsules  are  of  inestimable  value  in 
this  class  of  diseases.  They  relieve  congestion  of  the  womb 
by  allaying  the  irritation.  The  best  time  to  use  one  is  just 
before  retiring,  and  after  taking  a  sitz-bath,  or  a  vaginal 
injection  of  hot  water,  or  both.  Persons  who  are  of  a  cos- 
tive habit  should  pay  particular  attention  that,  about  the 
time  their  monthlies  come  around,  their  bowels  act  freely, 
and  to  accomplish  this  purpose  the  Femina  laxative  tablets 
should  be  taken,  one  each  night  for  several  nights  before 
the  courses  are  expected. 

MENORRHAGIA  AND  METRORRHAGIA. 

By  menorrhagia  is  meant,  as  the  composition  of  the  term 
implies,  an  excessive  flow  of  blood  at  the  regular  monthly 
period ;  by  metrorrhagia,  a  flow  of  blood  from  the  womb  at 
any  time  irrespective  of  the  regular  menstrual  periods. 
Neither  of  these  forms  can  be  called  a  disease,  as  they  are 
solely  the  symptoms  of  several  kinds  of  uterine  affections. 
In  the  course  of  our  investigations,  we  will  find  that  one 


144  HOME   TREATMENT. 

of  the  most  prominent  and  common  symptoms  of  different 
womb  diseases  is  hemorrhage  of  the  womb. 

If  the  hemorrhage  is  the  result  of  general  debility  from 
protracted  nursing,  the  child  must  be  weaned,  and  recipe 
No.  I,  with  a  nourishing  diet,  will  effect  a  cure. 

Hemorrhage  may  be  due  to  the  presence  of  a  fungoid  in- 
flammation, tumors,  or  affections  of  the  mouth  or  neck  of 
the  womb,  or  congestion  of  the  ovaries. 

It  is  very  often  due  to  a  "  bad  getting  up  "  from  confine- 
ment, where  the  womb  has  never  returned  to  its  original  size. 
Sometimes  it  is  due  to  a  portion  of  the  afterbirth  that  was 
retained  in  the  cavity  of  the  womb.  It  is  also  a  symptom  of 
cancer.  As  I  have  already  said,  it  may  be  the  symptom  of 
so  many  different  diseases  that  the  proper  course  to  pursue 
is  to  find  an  honest  and  competent  physician  to  make  a  thor- 
ough examination,  for  the  purpose  of  deciphering  the  real 
cause,  and  when  that  is  discovered,  it  is  as  a  rule,  an  easy 
matter  to  remove  it  and  thus  afford  the  patient  permanent 
relief. 

There  is  no  remedy  which  on  the  whole  is  so  effectual 
in  controlling  hemorrhage,  no  matter  from  what  cause,  as : 

NO.   IV. 

Take :  Fluid  ex.  of  ergot 1  ounce 

Dose:  a  teaspoonful  in  a  little  water  every  four  hours 
until  the  flow  ceases,  or  until  a  physician  is  consulted  to 
diagnose  the  case.  In  pregnancy,  the  administration  of 
ergot  is  not  admissible ;  cold  water  compresses  are  also  use- 
ful in  checking  uterine  hemorrhage,  and  the  utmost  quie- 
tude should  be  observed. 

Nervous  exhaustion  from  protracted  confinement,  or 
mental  worry  from  the  loss  of  a  child  or  the  death  of  a 
friend,  may  also  cause  uterine  hemorrhage.  The  ergot  is 
useful  in  these  cases,  with  a  change  of  air  and  scenery. 


CHAPTER  X. 

HISTOLOGY  OF  INFLAMMATION. 

Inflammations  of  the  various  tissues  assume  different 
forms  as  far  as  the  gross  appearances  are  concerned,  but  the 
underlying  condition  is  precisely  the  same.  The  various 
types  of  inflammations  that  are  produced  by  one  and  the 
same  process  are  of  considerable  scientific  interest,  but  to 
the  practical  and  inquiring  reader,  whose  principal  object  is 
to  obtain  sufficient  information  to  be  able  to  cure  herself,  it 
would  be  confusing  were  I  to  attempt  a  description  of  their 
differences. 

There  is  no  word  that  is  so  often  employed  as  inflamma- 
tion, as  a  designation  of  disease,  and  when  we  learn  that 
there  is  only  one  kind  of  inflammatory  process,  whether  of 
the  brain,  the  lungs,  liver,  kidneys  or  bowels,  the  entire  sub- 
ject of  inflammatory  diseases  at  once  becomes  greatly  sim- 
plified, because  if  you  understand  one  you  must  understand 
all. 

I  will  in  the  subsequent  chapters  speak  only,  or  princi- 
pally, of  inflammatory  affections  of  the  different  organs  that 
come  within  the  province  of  this  specialty,  and  I  am  con- 
vinced that  if  the  reader  will  bear  with  me,  so  that  I  may 
take  sufficient  time  and  space  to  explain  the  most  advanced 
scientific  views  of  inflammatory  processes,  she  will  be  more 
than  compensated,  by  a  clearer  understanding  of  what  will 
be  said  in  succeeding  pages. 

Inflammation  comprises  a  series  of  phenomena,  which 
partly  take  place  in  the  vascular  apparatus  or  blood  vessels 
and  partly  in  the  tissues  comprising  the  structure  of  the  or- 
gan. Inasmuch  as  inflammation  is  not  a  single  process,  a 
definition  of  a  few  words  is  insufficient  to  convey  to  the 

10  /145) 


146  HOME   TREATMENT. 

mind  its  real  meaning.  If  I  were  simply  to  describe  the  pe- 
culiarities of  the  circulation,  that  characterize  the  inflamma- 
tory process,  we  should  only  have  an  incomplete  idea  of  the 
changes  that  were  taking  place. 

Since  the  time  of  Galen,  who  lived  two  hundred  years 
after  Christ,  inflammation  was  recognized  by  four  cardinal 
symptoms,  namely  redness  (Ruber),  swelling  (Tumor),  pain 
(Dolor)  and  the  increased  temperature  (Calor).  To  these 
modern  pathologists  have  added  a  fifth  symptom,  which  is 
lessened  or  diminished  function  (Functio  l.esa). 

The  above  five  cardinal  symptoms  can  be  established  in 
the  majority  of  the  acute  stages  of  inflammation:  in  the 
chronic  or  subacute  variety,  one  or  the  other  symptom  may 
be  absent,  or  so  obscured  as  to  escape  notice. 

The  nature  and  structure  of  the  tissue  materially  modify 
some  symptoms  and  exclude  others,  so  that  redness,  pain 
and  even  perceptible  swelling  may  be  absent.  Galen  already 
in  his  time  attributed  the  redness  to  an  increased  blood  sup- 
ply and  the  swelling  to  an  exudation  of  lymph  or  serum, 
through  the  walls  of  the  blood  vessels:  this  was  as  near  the 
truth  as  scientists  arrived,  until  within  our  own  time.  The 
discoveries  in  this  field  of  science  have  been  greatly  en- 
riched in  the  last  twenty  years  through  the  researches  of  the 
German  school.  Various  theories  have  been  advanced  from 
time  to  time,  as  to  the  probable  causes  or  processes  that 
are  going  on  in  the  tissues  while  inflammation  is  active. 
One  observer  believed  that  he  had  found  the  solution  of  the 
inquiry  in  a  supposed  spasmodic  contraction  of  the  capillary 
blood  vessels,  another  in  their  paralysis,  while  still  another 
adhered  to  the  belief  of  a  neurotic  affection.  Professor  Vir- 
chow,  the  father  of  the  modern  school  of  pathological  science, 
ascribed  the  conditions  of  the  tissues  to  an  irritable  state  of 
the  inflammatory  process,  inducing  an  exaggerated  cell 
growth;  while  his  former  pupil,  Cohnheim,  through  an  ex- 
tended series  of  newly-devised  experiments,  has  conclusively 
proved  that  none  of  the  theories  advanced  are  supported  by 
demonstrable  facts. 


HISTOLOGY   OF   INFLAMMATION.  147 

Our  present  thorough  knowledge  of  the  combined  dis- 
turbances and  phenomena,  that  play  their  part  in  the  vessels 
and  tissues,  of  the  body  during  the  inflammatory  action  in 
living  tissue  is  due  to  the  unremitting  toil  of  Professor 
Cohnheim.  He  was  the  first  to  speak  from  facts,  as  they 
presented  themselves  to  his  eye  under  the  microscope.  It 
was  he  who  had  the  genius  that  suggested  the  examination 
of  the  whole  process  of  inflammation,  in  the  living  tissues 
under  the  microscope.  This  he  accomplished  by  narcotizing 
a  frog,  and  while  alive,  but  insensible  to  pain,  a  portion  of 
the  peritoneum  or  mesentery,  which  is  almost  transparent, 
so  that  the  circulation  may  be  plainly  seen,  was  fastened 
■with  pins  upon  an  ingeniously-devised  rack  or  stage.  The 
inflammation  is  now  excited  by  etching  the  membrane  with 
a  little  acid  and  a  sharp  needle,  and  then  the  object  is  placed 
under  the  microscope.  If  the  operator  is  careful,  so  as  not 
to  tear  or  crush  the  vessels  or  tissues,  and  preserves  the 
moisture,  by  spraying  with  warm  water  from  time  to  time, 
the  circulation  and  the  abnormal  processes  of  inflammation 
that  are  going  on,  may  be  observed  and  studied  with  great 
exactness  for  several  hours.  I  will  now  describe  what  may 
be  seen  in  the  field  of  the  microscope. 

The  first  change  to  be  observed  is  in  the  vascular  sys- 
tem and  within  the  vessels  themselves;  this  begins  with  a 
widening  of  the  small  arteries,  then  of  the  smaller  capillaries 
and  veins.  This  increases  the  current  of  blood  with  greater 
velocity  through  the  widened  vessels.  Sooner  or  later  this 
rapidity  of  the  current  lessens;  there  is  a  marked  slowness 
to  be  observed  in  the  stream.  The  single  or  separate  blood 
cells,  which  in  the  beginning  of  the  observation  could  not  be 
distinguished,  can  now  be  distinctly  seen,  especially  in  the 
veins  and  small  capillaries,  in  which,  from  the  slowness  of 
the  current,  the  blood  accumulates.  In  th«  veins  there  now 
appears  at  the  periphery  of  the  current  a  pellucid  plasmatic 
layer,in  which  there  are  white  blood  cells,  that  have  separated 
themselves  from  the  main  current;  the  white   cells  either 


148  HOME    TREATMENT. 

float  slowly  along  or  adhere  to  the  walls  of  the  vessels.  This 
phenomenon  the  Germans  term  "  Randstellung  der  Farb- 
losen  Blut  Kbrperchen,"  which  means,  bordering  of  white 
blood  corpuscles.  Not  long  after  the  "bordering"  of  white 
cells,  a  change  takes  place  in  the  cells  themselves,  that  is 
very  interesting.  The  white  cells  become  elongated  and 
spear-shaped  at  one  extremity,  which  pierces  the  wall  of  the 
vessel,  and  after  a  little  while  the  sharp  extremities  will 
appear  on  the  outer  surface  of  the  wall  of  the  vessel,  and 
a  little  later  on,  indeed,  the  entire  protoplasmic  cell  will 
have  emigrated  into  the  tissue,  outside  of  the  vessel.  Or,  in 
other  words,  the  colorless  blood  cells  will  have  passed  through 
the  walls  of  the  vein  or  capillary,  and  this  constitutes  an 
extravasation. 

The  first  extravasated  cells  will  soon  be  followed  by  oth- 
ers in  great  quantity,  so  that  in  six  to  eight  hours  veins  and 
capillaries  are  surrounded  with  white  corpuscles.  In  their 
normal  destination  these  become  organized  into  fibrous  or 
granulation  tissue;  and  for  this  reason,  an  organ  that  is  the 
seat  of  chronic  inflammation  becomes  immensely  enlarged 
from  this  inflammatory  accretion.  We  can  now  readily  ap- 
preciate why  the  womb,  liver  or  kidneys  become  augmented 
in  size  from  inflammatory  processes.  Indeed,  this  applies  to 
all  growths  and  even  to  bone,  and  if  a  part  is  injured  by  a 
cut,  accident  or  disease  of  some  sort,  precisely  the  same  proc- 
esses are  at  work  to  repair  the  lost  tissue.  It  cannot  fail  to 
become  apparent  at  once,  that  to  understand  the  phenomena 
of  inflammation  is  to  possess  the  key  that  opens  to  our  un- 
derstanding the  operations  not  only  of  most  diseases,  but  of 
the  healing  processes  of  wounds  and  injuries.  In  the  course 
of  the  experiment  we  see  also  red  blood  corpuscles  transude, 
which  are  always  accompanied  with  more  or  less  fluid  or 
plasma. 

The  above  detailed  account  seems  to  explain  in  a  clear 
manner  the  different  cardinal  symptoms  that  have  become 
recognized  features  of  inflammation  since  the  time  of  Galen. 


HISTOLOGY   OF   INFLAMMATION.  149 

The  great  vascular  activity  explains  the  redness,  swelling 
and  increased  temperature.  The  pain  can  be  traced  to  the 
pressure  from  the  exudation,  to  which  the  delicate  nerve  fila- 
ments were  exposed,  while  lessened  function  would  be  the 
natural  result  of  nerves  or  tissues  so  compromised. 

I  made  an  attempt  to  initiate  the  reader  into  the  science 
of  inflammatory  processes  and  if  I  have  succeeded  in  mak- 
ing myself  understood,  then  I  am  satisfied  with  having  im- 
parted a  most  useful  lesson,  because  there  is  no  process  in 
the  entire  field  of  disease  that  is  so  general;  it  is  almost  safe 
to  say  that  with  the  exception  of  functional  diseases,  there 
is  perhaps  no  class  of  diseases  with  which  an  inflammatory 
process  is  not  more  or  less  associated.  This  is  true  of  con- 
sumption, which  is  an  inflammatory  process  excited  by  and 
around  the  bacilli  or  micro-organisms,  and  these  inflam- 
matory nodules  are  called  tubercles.  The  growth  of  a  can- 
cerous tumor  is  associated  with  an  inflammation.  The 
development  of  a  common  boil  is  an  illustration  of  an  inflam- 
mation, breaking  down  or  destroying  part  of  the  tissue  which 
is  inflamed.  It  is  the  same  in  inflammation  of  the  lungs 
or  pneumonia  as  it  is  in  ordinary  catarrh;  the  differences 
that  are  presented  to  the  eye  are  only  modifications  of  de- 
gree and  peculiarities  that  are  due  to  the  difference  of  the 
tissues  of  which  the  organ  or  membrane  is  composed. 


CHAPTER  XI. 

URETHRITIS  AND  NEURALGIA  OF  THE  URETHRA. 

Inflammation  of  the  canal  by  which  the  urine  is  con- 
ducted and  discharged  from  the  bladder  is  termed  urethritis. 

There  is  no  organ  of  the  female  anatomy  that  is  oftener 
the  seat  of  local  inflammation. 

The  acute  and  chronic  inflammations  that  affect  the 
male  urethra,  also  affect  that  of  the  female,  only  perhaps  to 
a  more  limited  extent,  owing  to  the  comparative  smaller  mu- 
cous surface  of  the  tube,  it  being  only  from  an  inch  to  an 
inch  and  a  half  in  length. 

Inflammation  is  oftener  confined  to  this  portion  of  the 
urinary  apparatus  than  is  generally  supposed,  because  any 
derangements  of  these  parts  is  at  once  attributed  to  the 
bladder,  and  it  is  an  actual  fact  that  many  women  have  doc- 
tored uselessly  for  years,  for  the  one,  when  it  was  the  other 
that  was  diseased.  Symptoms  of  urethral  inflammations  are 
so  very  similar  to  inflammations  of  the  bladder  that  the 
points  of  distinction  are  easily  overlooked. 

The  trouble  begins  with  frequent  desire  to  void  urine 
and  a  continual  bearing  down  or  straining  sensation,  which 
may  be  accompanied  with  a  sense  of  heat  suggesting  to  the 
minds  of  the  most  chaste  and  pure  women,  sexual  desire,, 
which  the  gratification  of  that  indulgence  does  not  relieve 
nor  satiate,  but,  on  the  contrary,  the  sexual  passion  becomes 
only  exaggerated.  It  is  only  the  strongest  force  of  character 
and  Christian  fortitude  that  keep  some  of  these  unfortu- 
nate women  in  the  path  of  rectitude  and  virtue,  and  it  is- 
only  the  scientific  specialist  who  can  appreciate  the  real 
cause.    In  many  instances  women,  truly  noble  in  character, 

(no) 


URETHRITIS   AND    NEURALGIA.  151 

have  fallen  from  their  high  estate,  because  uncontrollable 
impulses  swept  them  into  the  maelstrom  of  licentiousness, 
which  might  have  been  averted,  if  they  had  known  of  whom 
to  seek  proper  advice. 

This  irritation  is  often  innocently  and  ignorantly  ac- 
quired in  early  girlhood  by  fingering  the  parts,  or  practicing 
masturbation,  which  sets  up  an  inflammatory  condition  of 
the  urethra  that  becomes  chronic,  and  in  time  may  entail  the 
terrible  consequences  to  which  I  have  already  alluded.  For 
that  reason  mothers  should  not  be  over-delicate;  they  should 
not  only  keep  a  watchful  eye  on  their  children  when  in  se- 
clusion, but  should  make  it  their  holy  duty  to  gradually  ini- 
tiate their  children  into  a  knowledge  of  physiology  and  of 
the  diseases  that  may  result  from  any  violation  of  youthful 
virtue. 

"Why  is  it  that  many  children  who  have  been  reared  in 
an  atmosphere  of  sanctity,  children  who  have  enjoyed  from 
their  earliest  recollection  moral  and  spiritual  administration, 
have  fallen  into  vice  and  depravity?  The  reader  should 
stop  to  answer  this  question  for  herself,  while  I  too  will  an- 
swer it  for  her. 

It  is  because  moral  teachers  overlook  the  fact  that  human 
beings  are  dual;  that  we  are  all  animal,  however  spiritual, 
and  that  the  functions  of  the  animal  nature  must  be  under- 
stood in  order  that  the  spiritual  nature  can  control  them. 

A  false  delicacy  has  entirely  neglected  this  part  of  the 
education  of  our  children,  which  I  stamp  as  the  height  of 
stupidity  and  hypocrisy. 

Among  other  causes  of  this  malady  is  hot  and  acrid 
urine,  or  gravelly  discharges  from  the  bladder,  cutting  and 
irritating  the  mucous  membrane  in  its  passage;  abrasions 
of  this  nature  often  lay  the  foundation  for  ulcers.  When 
the  urine  is  in  that  condition,  it  is  probably  due  to  a  com- 
plication of  diseases  of  the  bladder,  the  kidneys  and  the  liver. 
A  chemical  and  microscopical  examination  of  the  urine  will 
be  the  only  means  of  settling  these  questions. 


152  HOME   TREATMENT. 

The  urethra  often  takes  on  the  inflammations  of  the 
neighboring  tissue  or  organs;  disease  of  the  vulva  or  of  the 
vagina  will  spread  itself  to  the  urinary  canal.  I  have  seen 
cases  in  which  the  whole  trouble  was  traceable  to  a  catarrh 
of  the  neck  of  the  womb. 

Gonorrhceal  infection  of  the  vagina  will  in  the  great 
majority  of  cases  extend  itself  to  the  urethra  as  well  as  to 
the  cavity  of  the  womb  and  neighboring  organs. 

If  treatment  in  these  complicated  cases  is  to  be  success- 
ful, it  must  be  directed  to  the  disease  in  all  of  its  strongholds; 
this,  of  course,  can  only  be  done  under  the  direction  of  a 
skillful  specialist. 

There  is  a  predisposition  on  the  part  of  the  mucous  sur- 
faces to  become  infected  by  eruptions  of  the  eruptive  fevers, 
and  the  urethra  is  particularly  liable  to  this  invasion. 
Children  who  have  had  the  measles  and  scarlet  fever  will 
often  be  troubled  with  frequent  and  smarting  micturition 
and  after  convalescence  from  all  the  other  symptoms  of  the 
respective  fevers,  they  are  still  more  or  less  annoyed  for  weeks 
or  months  with  a  urethritis.  I  have  had  cases  of  this  nature 
that  dated  back  years.  If  the  early  treatment  is  neglected 
and  the  case  becomes  chronic,  it  generally  spreads  to  the 
bladder,  which  also  becomes  similarly  affected. 

Smallpox  pustules  are  apt  to  break  out  in  the  urethra 
during  the  acute  stage  of  the  disease,  and  excite  a  very 
itching  and  painful  urethritis.  Dysentery  in  children  may 
give  rise  to  the  disease.  In  adults  I  have  noticed  the  affec- 
tion in  connection  with  typhoid  fever,  but  this  generally 
passes  off  with  convalescence.  Hemorrhoids  or  piles  give 
rise  to  urethral  inflammation  which  does  not  yield  to  treat- 
ment, but  subsides  at  once  after  the  removal  of  the  piles. 
The  application  of  a  Spanish-fly  blister  to  any  part  of  the 
body  may  also  cause  a  stranguary  or  a  urethritis. 

Mothers  may  become  uneasy,  as  to  the  cause  of  the  muco- 
purulent discharge  from  the  urethra  of  their  little  girls.  I 
have  known  them  to  entertain  suspicion  of  some  specific 


URETHRITIS   AND   NEURALGIA.  153 

infection  being  introduced  into  the  genitals,  in  some  myste- 
rious manner;  a  little  inquiry  into  the  history  of  every  case, 
dispels  these  absurd  delusions,  and  it  will  be  found  that  pin- 
worms  have  caused  the  inflammation.  In  adults,  however, 
the  subject  should  be  made  the  object  of  particular  inquiry. 
During  delivery,  the  passage  of  the  child's  head  exerts  great 
pressure  on  the  urethra,  so  that  it  may  be  crushed  or  torn 
across.  Women  may  be  troubled  with  derangement  from 
this  cause  for  a  long  time,  or  for  their  whole  lives,  if  the 
real  cause  of  their  ailment  is  not  recognized.  Displace- 
ments of  the  womb  in  different  directions,  principally  when 
it  is  tipped  backwards  so  that  its  neck  impinges  on  the 
urethra  or  neck  of  the  bladder,  compresses  the  canal,  so  that 
its  caliber  is  diminished,  and  a  painful  obstruction  and  re- 
tention of  urine  ensue. 

Papillated  growths  and  mucous  polypoids  that  were  so 
small  that  they  were  hidden  from  external  sight,  but  readily 
detected  by  scientific  methods  of  examination  of  the  urethra, 
by  means  of  the  urethral  specula,  were  the  exciting  causes 
of  some  cases  that  came  under  my  treatment.  The  unfor- 
tunate victims  were  under  the  impression  that  their  kidneys 
or  their  bladders  were  diseased.  The  numerous  quack 
medicines  advertised  for  the  cure  of  these  maladies  were 
copiously  consumed,  doing,  of  course,  more  mischief  than 
good.  The  removal  of  the  growths  in  each  instance  at  once 
put  a  stop  to  any  further  inconvenience. 

In  pregnancy,  after  the  third  month,  the  womb  rises 
out  of  the  pelvis,  so  as  to  accommodate  its  increasing  size. 
This  naturally  drags  the  bladder  upwards,  and  so  stretches 
the  urethra  that  it  becomes  sore  and  extremely  irritable. 
To  relieve  this  distress  until  the  parts  have  accommodated 
themselves  to  their  new  relations,  the  Femina  vaginal  cap- 
sules are  of  the  greatest  value,  and  without  the  slightest  ill 
effect  arising  from  their  use.  Vaginal  irrigations  of  hot 
water  are  also  of  decided  benefit,  especially  before  using  a 
capsule. 


154  HOME    TREATMENT. 

Mix.  A  teaspoonful  to  be  given  to  an  adult  every  four 
hours  till  relieved. 

The  symptoms  of  inflammation  of  the  urethra  are  al- 
ways very  pronounced,  because  the  mucous  membrane  of 
the  urethra  is  the  most  sensitive  part  of  the  bladder.  In 
the  healthy  state  the  coloring  of  the  lining  membrane  is  of 
a  pale  red ;  when  inflamed  or  catarrhal,  it  assumes  a  dark 
red,  or  a  cherry  color.  The  membrane  is  also  considerably 
swelled  and  puffed,  and  feels  hot  to  the  touch,  and  imparts 
a  burning  sensation  to  the  patient.  The  muco-purulent  se- 
cretion excoriates  or  chafes  the  skin,  so  that  the  parts  look 
angry  and  red  in  the  neighborhood ;  this  is  oftener  observed 
in  children.  The  characteristic  symptom  of  frequently  uri- 
nating is  never  absent,  while  very  little  is  passed  at  a  time, 
yet  the  straining  to  pass  water  continues,  after  the  last  drop 
is  voided. 

The  treatment  is  cleanliness  to  begin  with.  In  grown 
people,  the  entire  vulva  and  vagina  must  be  rinsed  out  with 
a  warm  borax  solution,  in  the  proportion  of  one  teaspoon- 
ful of  the  powdered  borax  dissolved  in  a  quart  of  water. 
In  little  children  the  same  object,  that  of  cleanliness,  is  to 
be  accomplished  with  a  small  ear  syringe. 

After  the  external  parts  and  the  vagina  are  thoroughly 
cleansed,  then,  by  means  of  a  hard  rubber  syringe,  No.  1, 
three  or  four  syringefuls  of  clean  borax  water  are  injected 
into  the  urethra  for  the  purpose  of  cleaning  that  too.  To 
relieve  the  straining  and  frequent  desire  to  micturate,  which 
is  accompanied  with  more  or  less  pain,  I  give : — 

no.  v.i. 

Take:  Fluid  ex.  of  gelseminum 1  dram 

Sweet  spirits  of  nitre 7  drams 

Mix.  A  teaspoonful  in  a  wineglassful  of  water  three  or 
four  times  a  day  for  an  adult;  children  in  proportion. 

The  patient  must  confine  herself  to  a  bland  liquid  diet, 
principally  of  milk,  raw  eggs  beaten  up  in  bouillon  or  broth. 
Vegetables  may  be  eaten,  but  they  are  not  to  be  seasoned  with 


URETHRITIS   AND   NEURALGIA.  155 

anything  but  salt;  and  alcoholic  liquors,  wine  or  beer  must 
also  be  suspended  for  the  time  being. 

NEURALGIA   OP   THE   URETHRA. 

The  female  urethra  is  sometimes  the  seat  of  simple  neu- 
ralgia, by  which  is  meant  a  painful  condition  in  which 
there  is  no  apparent  disease  or  inflammation  of  the  tissues. 

This  pain  assumes  often  a  spasmodic  character;  that 
there  is  a  cause  for  this  is  certain,  but  it  is  as  a  rule  remote 
from  the  sensation  which  attracts  attention.  It  is  often 
found  to  be  the  symptom  of  some  of  the  diseases  to  which  I 
have  already  referred.  These  are  ulcerations,  displacements, 
or  inflammation  and  congestion  of  the  neighboring  organs. 
Abnormal  growths  or  tissues  will  often  be  painfully  reflected 
on  the  nerves  of  the  urethra.  I  remember  a  case  of  internal 
hemorrhoids,  which  was  never  suspected  by  the  patient  be- 
cause there  were  no  painful  symptoms  pointing  to  the  rec- 
tum, but  in  which  the  urethra  was  very  painful  in  its  entire 
extent.  The  suffering  from  this  urethral  neuralgia  had 
lasted  for  years,  but  disappeared  at  once,  on  the  removal  of 
the  piles.  I  have  called  attention  to  a  catarrhal  inflamma- 
tion of  the  urethra,  from  stretching  occasioned  by  the  as- 
cending womb  after  the  third  month  of  pregnancy;  there  is  a 
similar  pathological  process  after  the  seventh  month  of  gesta- 
tion, when  the  pregnant  womb  begins  to  descend  again  into 
the  pelvic  cavity,  and  this  is  particularly  marked  in  the  preg- 
nancy with  the  first  child,  when  the  pain  is  often  very  severe. 

If  in  a  first  pregnancy  there  is  no  abnormal  dispropor- 
tion between  the  dimensions  of  the  child's  head  and  the 
maternal  pelvis,  or  if  there  be  no  abnormal  position  of  the 
child,  then  there  is  an  obstetric  rule  that  the  womb,  or 
rather  the  child's  head,  begins  to  descend  into  the  pelvis  after 
the  seventh  month  of  gestation,  so  that  it  can  accommodate 
or  conform  itself  to  the  maternal  parts.  This  occasions  a 
drag  on  the  urethra  downwards  and  backwards,  which  is 
painfully  annoying,  and  there  is  a  constant  inclination  to 
pass  water. 


156  HOME   TREATMENT. 

There  are  two  mechanical  methods  of  relieving  this  dis- 
tressing symptom ;  one  is  to  obtain  as  much  rest  as  possible 
in  the  recumbent  position,  and  the  other  is  to  wear  an  ab- 
dominal supporter  or  bandage  around  the  lower  abdominal 
region,  so  as  to  take  the  weight  off  the  urethra.  The  in- 
ternal medication  consists  of  an  occasional  dose  of  a  mild 
laxative  medicine. 

In  the  newly  married,  the  urethra  becomes  sometimes 
the  seat  of  a  painful  spasmodic  contraction;  this  is  due  to  a 
tense  hymen,  which  should  be  slightly  nicked  with  a  pair 
of  scissors.  Exposures  to  colds  will  also  cause  neuralgia. 
Fresh  beer  and  sour  wine  make  the  urine  irritating,  and 
also  occasion  painful  symptoms. 

A  thorough  examination  of  the  mucous  membrane  of 
the  urethra  which  does  not  reveal  any  inflammatory  condi- 
tion or  abnormal  growth,  establishes  its  neuralgic  character. 
The  next  step  will  naturally  be  to  make  such  a  careful  ex- 
amination of  all  the  surrounding  tissues  and  organs,  for  the 
purpose  of  ferreting  out  the  real  cause.  When  the  cause  is 
removed  or  cured,  it  will  also  relieve  the  urethral  pain.  In 
the  absence  of  a  clear  comprehension  of  the  true  nature  of 
the  malady,  the  treatment  must  be  palliative.  The  sitz-bath 
is  always  one  of  the  most  palliative  measures  for  all  sorts  of 
pelvic  pains  and  aches.  Vaginal  injections  of  hot  water, 
not  too  hot,  from  105  degrees  to  108  degrees,  are  another 
sort  of  general  panacea, — the  quantity  of  fluid  should  be 
large,  from  half  to  one  gallon,  in  which  a  teaspoonful  of 
pulverized  borax  has  been  dissolved.  If  the  pain  is  very 
severe,  then  a  Femina  vaginal  capsule  should  be  used  every 
night  before  retiring,  and  immediately  after  having  used 
the  vaginal  irrigation.  The  bed  should  always  be  pre- 
viously warmed  with  a  hot  bottle,  unless  it  is  very  warm 
weather. 

If  the  urine  is  irritating,  a  cupful  of  buchu  tea  three  or 
four  times  a  day,  or  German  chamomile  tea,  should  be  drunk 
between  meals.  If  these  measures  do  not  give  relief,  then 
consult  an  honest,  competent  physician,  in  whose  integrity 
you  can  rely. 


CHAPTER  XII. 

INFLAMMATION,  CATARRH,  AND  OTHER  DIS- 
ORDERS OF  THE  BLADDER. 

The  female  bladder  is  easier  approached  than  that  of  the 
male.  This  is  clearly  illustrated  in  the  anatomical  Plate  II, 
which  should  be  thoroughly  studied  before  this  chapter  is 
read. 

The  bladder  lies  directly  behind  the  symphysis  pubis, 
above  or  in  front  of  the  vagina.  On  account  of  the  com- 
parative shortness  of  the  female  urethra,  to  that  of  the  male, 
the  cavity  of  the  bladder  is  also  much  more  accessible 
through  this  channel,  and  if  access  through  this  communi- 
cation does  not  suffice,  then  the  interior  of  the  female  blad- 
der may  be  exposed  by  an  incision  through  the  anterior 
wall  of  the  vagina,  but  this  resource  becomes  rarely  neces- 
sary. Formerly  we  had  to  content  ourselves  with  external 
appearances,  that  were  confined  to  the  external  anatomy  of 
the  urinary  canal  on  the  anterior  vaginal  wall,  aided  only 
by  a  delicate  sense  of  touch.  Valuable  as  these  means  of 
examination  sometimes  were,  they  were  far  from  satisfactory 
to  either  physician  or  patient.  Now  we  are  able  to  examine 
with  the  finger,  aided  with  the  eyes,  almost  the  entire  lining 
of  the  bladder. 

Professor  Simon,  of  Heidelberg,  was  the  inventivegenius  of 
this  improved  method  of  examination,  by  means  of  a  series 
of  graded  specula  or  hard  rubber  bougies,  which  are  known 
by  his  name.  The  specula  are  simply  small,  smooth,  pin- 
shaped,  hard  rubber  bougies,  about  three  inches  in  length, 
beginning  with  a  size  that  is  three-tenths  of  an  inch  in  di- 
ameter, to  the  largest,  which  is  eight-tenths  of  an  inch  in 

(157) 


158  HOME    TREATMENT. 

thickness.  These  are  carefully  introduced  into  the  urethra, 
commencing  with  the  smallest  size,  which  is  retained  for  a  few 
minutes  and  then  withdrawn,  and  the  next  size  inserted,  and 
this  continued  until  the  largest  one  has  been  inserted,  or  the 
required  dilatation  accomplished,  either  for  the  purpose  of  in- 
troducing the  finger  into  the  bladder,  or  exposing  its  lining 
membrane  for  inspection.  While  this  procedure  does  not  fall 
into  the  sphere  of  home  treatment,  it  is  of  sufficient  interest 
to  women  in  general  that  they  should  know  what  can  ac- 
tually be  accomplished  by  the  expert  specialist.  Were  I  to 
review  the  malformations,  or  dislocations,  of  the  bladder,  or 
the  history  of  stones  in  the  bladder,  or  other  foreign  bodies, 
that  the  female  specialist  is  very  seldom  called  upon  to  treat, 
I  should  only  worry  the  patience  of  the  reader  with  things 
that  she  would  not  readily  understand.  The  same  is  true 
of  growths  and  tumors  of  the  bladder,  which  have  princi- 
pally a  scientific  interest  for  the  practitioner  of  medicine, 
but  for  the  casual  reader  they  are  too  profound  in  their  de- 
tails for  a  clear  understanding. 

INFLAMMATION. 

Inflammation  of  the  bladder  is  in  medical  language 
termed  cystitis.  It  presents  itself  under  two  varieties  or  sub- 
divisions, acute  and  chronic,  depending  on  the  duration, 
whether  recent  or  protracted. 

The  disease  begins  in  the  mucous  membrane,  and  the 
acute  inflammation  comes  on  suddenly.  It  rarely  occupies 
the  entire  mucous  surface  of  the  bladder,  but  usually  occurs 
in  irregular  spots.  Some  spots  are  as  large  as  the  palm  of 
the  hand,  while  others  are  only  the  size  of  a  ten-cent  piece. 
The  parts  that  are  most  frequently  affected,  are  the  neck  of 
the  bladder  and  its  posterior  wall,  although  no  portion  of 
its  lining  membrane  is  exempt  from  inflammation. 

It  rarely  happens  that  the  inflammation  spreads  over 
the  entire  extent  of  the  bladder,  or  that  it  invades  the  mus- 
cular tissue;  if  it  should  complicate  the  latter,  it  would  involve 


DISEASES   OF   THE   BLADDER.  159 

the  peritoneum;  this  would  add  a  very  serious  complication, 
namely,  a  peritonitis.  Cystitis  may  be  due  to  an  extension 
of  gonorrhoeal  infection  from  the  vagina  and  urethra,  or 
from  other  purulent  affections.  Women  who  are  unable  to 
pass  water  after  confinement,  may  be  liable  to  the  disease 
from  retained  urine,  decomposing  in  the  bladder  and  caus- 
ing inflammation.  On  the  other  hand,  a  filthy  catheter 
used  by  a  midwife  or  doctor  who  is  careless  or  ignorant  of 
the  necessary  antiseptic  precautions,  and  who  fails  to  brush 
and  boil  out  the  catheters,  and  uses  one  catheter  on  differ- 
ent patients,  without  the  precaution  of  even  thoroughly 
rinsing  it,  may  give  rise  to  dangerous  cystitis.  The  most 
serious  case  that  I  ever  have  seen  was  directly  traceable  to 
this  cause.  If  impure  air  gets  into  the  bladder  this  will  also 
excite  cystitis;  to  prevent  that,  is  to  close  with  the  finger  the 
outlet  of  the  catheter  that  is  used  for  drawing  off  the  urine, 
when  withdrawing  the  instrument,  a  precaution  seldom  ob- 
served. 

Newly-brewed  malt  liquors,  alcoholic  stimulants  taken 
in  excess,  diuretics  of  spirits  of  turpentine  and  cantharis, 
or  highly-seasoned  and  rich  food,  are  among  the  exciting 
causes;  irritating  injections  into  the  bladder  or  vagina,  and 
even  cold-water  injections  into  the  vagina,  must  be  added  as 
exciting  causes  of  this  painful  affection.  Venereal  excesses 
operate  in  exciting  visceral  inflammation,  and  when  the 
slightest  symptoms  are  felt,  prudence  and  good  common 
sense  dictate  continence.  The  first  feeling  that  manifests  it- 
self is  a  dull,  heavy,  aching  sensation,  immediately  after  uri- 
nating, and  an  involuntary  inclination  to  further  relieve  or 
empty  the  bladder  by  pressing  or  bearing  down.  Soon  after 
the  first  indication  to  void  urine,  there  is  another  desire  to 
empty  the  bladder,  and  the  same  symptoms  repeat  them- 
selves, only  in  a  more  aggravated  form.  The  distress  of 
micturition  gradually  becomes  continuous  so  that  during  the 
short  intervals  between  the  times  that  urine  is  voided,  and 
as  the  disease  progresses,  the  pain  becomes  sharper.     This  is 


160  HOME   TREATMENT. 

accompanied  by  a  kind  of  gnawing  uneasiness  in  the  region 
of  the  whole  bladder,  which  has  intermissions,  but  is  greatly 
increased  when  the  desire  to  make  water  is  felt.  If  the  dis- 
ease progresses,  the  pain  is  now  felt  in  the  neighboring  or- 
gans and  a  general  constitutional  disturbance  manifests  it- 
self. The  patient  will  now  generally  have  a  severe  chill ; 
this  is  followed  with  heat  and  thirst  and  an  increase  in  the 
pulse.  The  desire  to  void  urine  at  shorter  intervals  becomes 
more  prominent  and  only  drop  by  drop,  accompanied  with 
distressing  spasm  and  a  burning  sensation  along  the  urinary 
canal. 

The  region  of  the  bladder  becomes  in  the  advanced  stages 
of  inflammation  extremely  sensitive  and  tender,  and  if  the 
peritoneum  is  involved,  even  the  weight  of  the  bedclothes 
becomes  intolerable.  The  limbs  are  drawn  up  and  the  body 
is  inclined  forward  to  relieve  the  tension  of  the  abdominal 
muscles  and  their  pressure  on  the  bladder. 

The  neighboring  organs  begin  to  sympathize  with  the 
advanced  state  of  the  inflammation  at  this  stage;  cutting 
pains  are  felt  in  the  rectum,  while  darts  of  pain  shoot  from 
the  bladder  towards  the  groins  and  ovaries. 

Owing  to  the  spasmodic  action  of  the  urethra,  the  bladder 
is  never  completely  emptied  so  that  the  urine  gradually  ac- 
cumulates in  abnormal  proportions;  the  retained  urea  rap- 
idly decomposes  into  ammonia  and  the  urine  becomes  very 
hot  and  irritating,  thus  greatly  augmenting  the  suffering. 
Under  these  circumstances,  the  bladder  may  become  greatly 
distended  and  feel  as  a  sensitive  globular  tumor  above  the 
pubis.  The  retention  of  the  urine  may  be  complete,  owing 
to  a  partial  paralysis  of  the  bladder  and  now  complicated 
with  spasmodic  stricture.  Nausea  and  vomiting  are  rarely 
absent  in  this  stage,  the  tongue  becomes  coated  and  dry, 
while  the' expression  is  anxious  and  the  fever  very  high. 

In  the  commencement  of  the  disease  there  is  some  differ- 
ence in  the  symptoms  of  inflammation  of  the  bladder  which 
arises  from  the  nature  and  seat  of  the  inflammatory  process. 


DISEASES   OF   THE   BLADDER.  161 

If  the  neck  of  the  bladder  is  mainly  affected,  the  spas- 
modic desire  to  urinate  is  more  pronounced,  and  the  pain  is 
felt  low  down  in  the  vagina  and  anus,  while  the  symptoms 
are  higher  up  in  the  rectum,  with  constant  inclination  to  go 
to  stool,  if  the  base  or  posterior  wall  of  the  organ  is  princi- 
pally involved. 

Acute  cystitis  runs  its  course  in  six  or  eight  days;  under 
favorable  circumstances  and  appropriate  treatment  all  pain- 
ful symptoms  will  in  that  time  have  subsided,  and  the  pa- 
tient will  have  entered  upon  a  course  of  permanent  recovery. 

If  through  a  constitutional  habit,  or  through  neglect  or 
improper  treatment,  the  disease  is  not  curbed,  the  result 
will  be  quite  different;  the  inflammation  may  pass  into  a 
suppurative  stage  or  assume  the  chronic  form. 

The  treatment  in  the  acute  stage  will  resolve  itself  into 
two  different  measures  of  relief;  these  are  first  to  subdue  the 
spasmodic  pain  and  nervous  excitement,  and  secondly,  to 
quiet  the  local  irritation.  The  pain  is  best  controlled  by 
morphine  powders,  one-fourth  of  a  grain  each,  given  every 
four  hours.  Warm  teas  of  German  chamomile  or  flaxseed, 
so  as  to  dilute  the  urine,  may  be  freely  given.  Hot  vaginal 
injections  of  borax  water  have  a  remarkably  soothing  influ- 
ence; the  hot  sitz-bath  is  another  useful  adjuvant.  It  has 
been  customary  in  this  country  and  England,  to  apply  hot 
water  compresses  or  hot  poultices  over  the  hypogastrium, 
which  is  that  part  of  the  lower  abdomen  corresponding  to 
the  region  of  a  distended  bladder. 

After  eight  years  of  extended  experience  in  this  country, 
and  a  thorough  trial  of  hot  fomentations  for  inflammatory 
affections  of  the  abdomen,  I  became  convinced  that  the  Ger- 
man method  of  cold-water  compresses  gives  more  relief  and 
is  more  in  the  nature  of  an  abortive,  hence  curative. 

I  recommend  to  my  patients,  instead  of  the  hot-water 
applications,  a  rubber  bag,  filled  with  broken  pieces  of  ice, 
and  applied  over  the  region  of  the  bladder. 

The  bowels  should  be  freely  moved  with  castor  oil  or  a 
dose  of  salts  and  senna,  or  by  an  enema  of  warm  soapsuds 
11 


162  HOME   TREATMENT. 

The  food  should  be  bland  and  of  a  fluid  nature  as  nearly 
as  possible,  broths  with  an  egg,  milk  gruels  or  bread  and 
milk. 

CHRONIC   CYSTITIS. 

If  the  acute  attack  of  cystitis  in  the  course  of  eight  or 
ten  days  becomes  modified,  but  convalescence  is  not  estab- 
lished, then  it  is  quite  probable  that  the  disease  is  drifting 
into  a  chronic  stage. 

The  mucus  or  slime  that  formerly  accompanied  the 
urinary  discharge  is  now  assuming  the  character  of  matter 
or  has  become  muco-purulent.  While  this  is  a  very  rare 
symptom  of  the  acute  variety  of  cystitis  and  usually  of  brief 
duration,  in  chronic  inflammation  it  is  one  of  the  charac- 
teristics of  the  malady,  and  often  lasts  for  a  long  time;  the 
muco-purulent  fluid  is  occasionally  remarkably  profuse. 

The  pus  is  not  always  furnished  by  the  free  surface  of 
the  mucous  membrane,  but  may  be  traced  to  small  abscesses, 
situated  in  the  tissue  between  the  mucous  membrane  and 
the  muscular  wall  of  the  bladder.  The  locality  for  the  for- 
mation of  these  abscesses  is  principally  at  the  neck  of  the 
organ,  although  there  is  no  part  of  the  organ  that  is  entirely 
exempt  from  them.  Fortunately,  the  abscesses  generally 
point  inwards  or  towards  the  cavity  of  the  bladder,  but  it 
not  infrequently  happens  that  they  break  through  and  empty 
into  the  vagina  or  even  into  the  adjacent  bowel  or  abdomi- 
nal cavity. 

The  occurrence  of  pus  or  suppuration  is  by  itself  so 
grave  a  process  that  it  is  always  accompanied  with  certain 
well  marked  and  stereotyped  symptoms,  which  are  cold 
chills,  alternating  with  flushes  of  heat,  increase  of  heat  or 
fever,  anxiety  and  restlessness.  The  pain  now  becomes  dull 
and  throbbing  in  character,  and  the  burning  or  stinging  is 
only  felt  when  the  patient  urinates.  When  there  are  ab- 
scesses, the  nervous  derangement  may  be  so  great  as  to 
cause  the  mind  to  wander  in  delirium.  Before  the  appear- 
ence  of  pus  in  the  urine,  nothing  but  a  skillful  examination 
can  establish  the  existence  of  an  abscess. 


DISEASES   OF   THE    BLADDER.  1G3 

The  treatment  for  suppuration  of  the  bladder,  when 
limited  to  the  surface  of  the  mucous  membrane,  is  always 
curable  with  intelligently-directed  treatment,  which  is  the 
same  as  that  for  chronic  catarrh  of  the  bladder,  to  be  de- 
tailed further  on. 

ULCERATION  OF  THE  BLADDER. 

This  is  perhaps  seldom  a  condition  by  itself,  but  rather  a 
complication  of  the  preceding  disease.  The  ulcers  occupy 
the  place  of  what  were  formerly  little  abscesses,  that  have 
broken  into  the  cavity  of  the  organ.  Foreign  bodies  in  the 
bladder  by  their  direct  pressure  on  the  delicate  tissues  of  the 
membrane  have  been  the  cause  of  ulcerations,  that  gave 
rise  to  dangerous  hemorrhage.  Earthy  concretions  or  stones 
will  naturally  form  in  the  bladder,  and  the  end  of  a  gum 
catheter  has  also  been  found  in  the  bladder  broken  off  in  the 
bungling  act  of  drawing  off  the  urine,  or,  what  is  more 
likely,  by  boring  and  poking  within  the  cavity  of  the  blad- 
der, with  a  catheter  or  bougie,  by  persons  ignorant  of  pelvic 
anatomy  or  in  the  belief  that  the  bougie  was  in  the  cavity 
of  the  womb,  for  the  purpose  of  inducing  an  abortion. 

Ulcerations  will  always  be  accompanied  with  more  or 
less  inflammation  or  visceral  catarrh,  so  that  the  symptoms 
will  fall  under  that  head  which  has  already  been  considered. 

CATARRH  OR  SUBACUTE  INFLAMMATION. 

The  mucous  membrane  of  the  bladder,  like  that  of  the 
nose,  mouth  or  bronchial  tubes,  has  its  natural  secretion  of 
healthy  mucous.  When  any  of  these  membranes  become 
irritated  or  congested  from  any  cause,  this  natural  secretion 
becomes  so  increased  as  to  make  a  perceptible  flow  of  the 
secretion  of  mucus,  and  this  is  what  the  term  catarrh  sig- 
nifies. Catarrhs  always  presuppose  the  existence  of  inflam- 
mation, which  in  its  nature  is  subdued  or  mild,  so  that  it 
has  been  qualified  as  subacute,  which  is  intended  to  convey 
the  idea  that  the  tissue  need  not  be  red  nor  hot  and  swollen 
as  is  always  the  case  in  the  acute  form  of  inflammation. 


164  HOME    TREATMENT. 

Chronic  catarrh  of  the  bladder  is  traceable  to  any  or  all 
the  causes  that  have  been  enumerated  in  the  acute  processes,, 
because  every  acute  inflammation  of  the  bladder  may  termi- 
nate in  a  chronic  form.  It  occurs  at  any  period  of  life,  but 
it  is  most  common  in  elderly  subjects;  it  is  always  an  at- 
tendant of  ulceration  of  the  bladder  or  some  abnormal 
growth  in  the  bladder.  If  the  disease  is  once  established  and 
is  due  to  a  complication,  it  is  liable  to  become  aggravated  or 
re-established  after  a  brief  subsidence  by  exposure  to  cold, 
excesses  in  diet  and  drink,  or  diseases  of  the  vagina,  uterus 
or  rectum. 

The  secretion  of  catarrh  is  white  and  glairy  and  resem- 
bles the  discharge  of  leucorrhoea  or  ivhites.  When  disas- 
sociated with  acute  inflammation  of  the  bladder,  it  comes  on 
gradually,  or  in  a  slow,  insidious  manner;  for  this  reason 
the  term  subacute  inflammation  is  sometimes  employed  by 
authors,  because  there  are  no  fiery  symptoms  at  the  onset  of 
the  affection. 

The  urine  is  always  more  or  less  altered  in  character, 
because  the  inflamed  mucous  membrane  predisposes  the 
urine  to  speedy  decomposition.  There  is  frequent  and  diffi- 
cult micturition,  and  the  entire  region,  but  in  particular  the 
affected  organ,  is  more  or  less  sensitive  and  sore. 

The  quantity  of  mucus  which  passes  off  with  the  urine 
varies  greatly  at  different  periods  and  in  different  cases. 
In  the  early  stages  it  may  entirely  escape  notice,  being  so 
small  that  if  the  urine  is  not  saved  in  a  vessel  and  accu- 
mulated for  the  twenty-four  hours  the  mucus  can  hardly 
be  detected;  thus,  the  entire  quantity  of  the  above  period 
may  often  not  exceed  two  teaspoonfuls.  When  the  disease 
becomes  more  advanced,  the  quantity  of  mucus  may  be 
equal  to  the  quantity  of  urine  that  passes.  The  secretion  is 
very  thick  and  sticky,  and  settles  to  the  bottom  of  the  vessel 
or  adheres  to  its  surface.  If  there  is  pus  mixed  with  the 
mucous  secretion,  it  becomes  a  more  serious  question,  and  it 
may  then  be  inferred  that  other  organs  are  involved,  the 


DISEASES   OF   THE   BLADDER.  165 

conductors  of  urine  from  the  kidneys  to  the  bladder,  for 
instance,  or  the  kidneys  themselves.  If  the  disease  is  con- 
fined to  the  bladder,  the  prospects  for  a  cure  are  very  favor- 
able; only  when  diseases  of  other  organs  in  the  neighbor- 
hood are  the  exciting  causes  of  the  malady  are  the  chances 
for  a  cure  correspondingly  limited. 

The  success  of  any  treatment  will  depend  in  a  great 
measure  upon  the  nature  of  the  exciting  causes.  These  re- 
quire to  be  removed,  if  within  the  possibility  of  medical 
skill,  before  the  catarrh  can  be  made  to  subside. 

Should  the  mucous  or  muco-purulent  secretion  be  very 
-abundant,  the  bladder  must  be  thoroughly  rinsed  out;  first 
once  every  twenty-four  hours,  and  afterwards  every  other 
day,  so  that  the  mucous  membrane  will  be  cleansed  from 
all  foreign  irritating  elements.  I  am  employing  for  this 
purpose  Thiersche's  Boro-Salicylic  solution.  This  of  course 
•can  only  be  carried  out  by  a  skillful  physician. 

When  the  disease  is  in  its  incipient  stage  it  is  amen- 
able to  intelligently-directed  home  treatment. 

The  most  perfect  rest  of  mind  and  body  is  one  of  the 
•essentials  to  success,  the  entire  suspension  of  stimulating 
drinks  of  an  alcoholic  nature,  of  which  beer  is  the  most 
irritating,  and  tea  or  coffee  must  be  discarded.  A  milk 
and  vegetable  diet  is  the  most  beneficial  to  subsist  on,  and 
all  condiments,  even  salt,  must  be  dispensed  with. 

If  the  bowels  are  costive  they  must  be  regulated  either 
by  means  of  enemas  of  warm  water,  or  what  may  prove  of 
greater  and  more  lasting  benefit  is  the  use  of  Femina  laxa- 
tive tablets.  One  tablet  should  be  taken  every  night  at  bed- 
time, and  if  one  operates  too  much,  then  one  every  other 
night  may  be  all  that  is  required. 

Demulcent  drinks  of  flaxseed  tea,  or  slippery-elm  water, 
should  be  drunk  freely,  and  for  the  catarrh  of  the  bladder 
there  is  no  prescription  that  ever  gave  me  the  same  satis- 
factory results  as  this  one : — 


166  HOME    TREATMENT. 

NO.   VI. 

Take:  Borate  of  soda 2  drams 

Fluid  ex.  of  gelseminum 1  dram 

Fluid  ex.  of  belladonna x  drops 

Fluid  ex.  of  buchu 1£  ounces 

Fluid  ex.  of  senna 1|  ounces 

Distilled  water 2  ounces 

Syrup  of  orange  peel  sufficient  to  make  8  ounces 

Mix,  and  take  a  tablespoonful  or  less  three  times  a  day 
Wear  flannel  drawers  and  woolen  hose,  so  as  to  guard 
against  sudden  changes  of  the  weather. 

NEURALGIA    AND    NERVOUS    IRRITABILITY. 

The  bladder  is  often  the  seat  of  functional  derangements 
that  are  characterized  by  a  morbid  sensibility  and  pain. 

The  principal  symptom  of  this  disease  is  a  frequent  de- 
sire to  urinate.  A  careful  examination  of  the  urine  reveals 
nothing  abnormal  in  the  fluid  that  would  point  to  the 
slightest  affection  of  the  bladder,  nor  are  any  of  the  symp- 
toms that  characterize  inflammation  present.  There  is  no 
mucous  sediment,  but  in  a  large  proportion  of  cases  there  is 
an  abnormal  deposit  of  the  phosphates  that  would  point  to 
nerve  waste.  There  is  often  a  similar  irritability  in  the 
vaginal  canal,  in  fact,  there  is  such  a  mutual  sympathy  be- 
tween the  two,  which  can  hardly  be  located  in  any  one  par- 
ticular organ. 

Hemorrhoids  and  constipation  are  sometimes  found  to  be 
the  cause. 

In  women  of  a  nervous  temperament  the  bladder  often 
becomes  the  seat  of  a  steady  neuralgic  pain.  Sometimes 
this  pain  is  periodical,  recurring  every  day  and  about  the 
same  hour  and  lasting  the  same  period.  This  pain  is  of  a 
lancinating  character,  and  radiates  from  the  bladder  to  the 
neighboring  organs.  I  have  noticed  these  symptoms,  par- 
ticularly in  women  who  had  lived  in  malarial  districts,  and 
whose  blood  had  become  impoverished  by  malarial  fevers, 
or  from  excessive  hemorrhages  due  to  some  uterine  trouble. 


DISEASES   OF   THE   BLADDER.  1G7 

Sexual  excesses  and  other  abuses  that  lower  the  tone  of 
the  nervous  system  will  also  develop  a  neuralgic  condition 
of  these  parts.  Persons  who  seek  relief  from  this  distressing 
complaint  must  first  abandon  their  vices  before  they  can 
expect  alleviation  from  any  treatment.  This  affection  is 
not  in  itself  dangerous,  but  the  frequent  recurrence  of  par- 
oxysms of  pain  render  life  miserable.  If  the  general  system 
requires  toning  up,  I  would  recommend  the  iron  pills  after 
Formula  I,  with  a  good  liberal  diet  of  eggs  and  milk.  For 
immediate  relief  of  the  painful  spasms,  the  sitz-bath  and 
hot  vaginal  injections  are  of  great  value.  And  for  the  irri- 
table bladder  I  can  recommend : — 

NO.    VII. 

Take:  Bromide  of  sodium 3  drams 

Fluid  ex.  of  gelseminuni 1  dram 

Water  sufficient  to  make 8  ounces 

Mix,  and  take  a  tablespoonful  three  times  a  day. 

The  gouty  and  rheumatic  bladder  is  so  very  rare  that  a 
detailed  description  is  hardly  necessary.  But  it  might  be 
well  to  remind  the  reader  that  if  she  is  of  a  gouty  or  rheu- 
matic disposition  and  has  also  bladder  trouble,  it  may  be 
due  to  the  bladder  being  compromised  or  influenced  by 
gout  or  rheumatism.  In  that  case,  appropriate  treatment 
directed  to  the  rheumatic  diathesis  will  also  cure  the  bladder. 

PARALYSIS. 

The  female  bladder  becomes  paralyzed  from  various 
causes;  some  of  these  are  located  in  the  organ  itself,  while 
others  are  due  to  disease  of  the  brain  or  spinal  cord.  An 
obstruction  to  the  flow  of  urine  through  the  urethra  causes 
the  bladder  to  become  overdistended  with  urine  and  in- 
duces paralysis.  A  prolonged  pressure  from  the  child's 
head  during  delivery  is  oftener  the  cause  of  transient  paral- 
ysis than  any  other.  It  happens  that  lying-in  women  can- 
not pass  their  urine  for  several  days  after  confinement. 
Violence   from  without,  as  a  blow  or  a  kick,  may  have  a 


168  HOME   TREATMENT. 

similar  effect.  This  results  from  the  pressure  to  which  the 
bladder  was  subjected.  Operations  on  the  rectum,  vagina, 
or  any  of  the  pelvic  organs,  are  frequently  followed  by  a 
partial  or  complete  paralysis.  In  all  these  cases,  there  is 
only  one  precaution  to  observe,  and  that  is  to  draw  off  the 
urine  at  regular  intervals  so  as  to  avoid  an  enormous  accu- 
mulation of  fluid. 

The  paralysis  becomes  dangerous  and  obstinate  to  treat- 
ment, in  proportion  as  the  bladder  becomes  abnormally  dis- 
tended, and  the  length  of  time  that  the  muscular  tissues  are 
under  the  excessive  strain. 

In  those  cases  where  the  paralysis  is  due  to  spinal  or 
brain  disease,  there  is  little  prospect  of  a  cure.  In  other 
cases,  as  for  instance  after  confinement  or  an  operation  on 
the  rectum  for  piles  or  fistula,  it  generally  passes  off  in  a 
few  days. 

Great  care  and  cleanliness  must  be  exercised  in  using 
the  catheter,  so  that  the  bladder  ig  not  infected  from  filth  or 
virus  from  another  patient.  A  catheter  that  has  been  em- 
ployed on  a  patient  who  had  her  urine  drawn  off  while  she 
suffered  from  purulent  catarrh  or  puerperal  fever,  will  inoc- 
ulate a  healthy  person  with  the  same  disease,  and  in  this 
manner  diseases  are  often  communicated.  The  bladder  is 
exceedingly  liable  to  infection. 

HEMORRHAGE. 

A  discharge  of  blood  from  the  bladder  is  not  of  frequent 
occurrence,  but  it  occurs  often  enough  to  make  it  noteworthy, 
and  women  should  at  least  know  that  there  is  such  a  thing. 
It  oftener  takes  place  in  men  than  in  women,  as  a  symptom 
of  some  grave  or  serious  disease,  or  it  may  be  only  a  trivial 
disorder.  Hemorrhage  of  the  mucous  membrane  takes  place 
very  readily,  owing  to  the  delicacy  of  the  tissues  and  the  great 
vascularity  of  the  submucous  layer,  and  there  is  a  much  greater 
tendency  to  hemorrhage  in  some  persons  than  in  others. 

Persons  who  are  weak  and  debilitated  bleed  much  easier 


DISEASES   OF   THE   BLADDER.  169 

than  strong,  vigorous  ones,  because  the  blood  may  become 
so  thin  or  poor  in  fibrin  that  it  greatly  loses  its  property  of 
coagulating.  Some  diseases  bring  this  particular  diathesis 
about,  such  as  scurvy,  also  measles,  scarlatina  or  small- 
pox. Worms  have  been  found  to  make  their  way  from  the 
rectum  into  the  cavity  of  the  bladder,  and  caused  profuse 
and  even  fatal  hemorrhage.  A  violent  fall  of  the  body, 
rupturing  an  artery  in  the  bladder,  severe  horseback  riding, 
and  venereal  excesses,  have  all  caused  almost  fatal  hemor- 
rhages, to  which  must  be  added  ulceration  of  the  mucous 
membrane.  The  most  profuse  hemorrhage  of  the  bladder 
that  I  was  ever  called  upon  to  witness,  followed  drinking  a 
strong  decoction  of  wormwood;  irritating  diuretics,  like 
spirits  of  turpentine  or  tincture  of  cantharides,  are  also  liable 
to  cause  bleeding.  Hemorrhage  is  always  accompanied 
with  frequent  desire  to  pass  urine  and  spasmodic  pains  at 
the  neck  of  the  bladder.  The  blood  may  also  coagulate  in 
the  bladder,  causing  an  obstruction.  The  treatment  con- 
sists principally  in  keeping  the  patient  very  quiet,  and  a 
rubber  ice  bag  should  be  applied  over  the  region  of  the 
bladder;  nothing  but  bland  liquid  food  is  advisable,  but  no 
hot  drinks  are  permissible.  If  the  urine  does  not  pass,  a 
soft  rubber  catheter  should  be  employed  for  the  purpose  of 
drawing  it  off. 

Hemorrhages  of  the  mucous  membrane,  whether  of  the 
bladder,  the  bowels  or  lungs,  generally  yield  to  the  follow- 
ing mixture: — 

NO.   VIII. 

Take:  Gallic  acid 4  scruples 

Tr.  of  digitalis £  ounce 

Fluid  ex.  of  ergot 1  ounce 

Simple  syrup \  ounce 

Mix,  and  give  a  teaspoonful  in  a  little  water  every  four 
hours;  children  in  proportion. 

URINARY  FISTULA. 

By  this  is  meant  a  permanent  unnatural  opening  into 
he  bladder  from  without,  through  which  urine  escanes. 


170  HOME   TREATMENT. 

The  situation  of  the  female  bladder,  just  in  front  and 
over  the  vagina,  and  also  its  attachment  to  a  portion  of  the 
cervix  or  neck  of  the  womb,  exposes  it  to  injuries,  especially 
from  pressure  of  the  child's  head  during  delivery.  By  re- 
ferring to  Plate  II,  it  will  be  seen  at  a  glance  how  easily 
an  accident  can  take  place  from  this  cause.  It  was  at  one 
time  supposed  that  delivery  by  forceps  was  the  most  fruit- 
ful cause  of  this  lesion.  That  this  is  likely  to  happen  only 
where  the  instrument  is  in  incompetent  or  bungling  hands, 
there  is  no  reasonable  doubt.  A  thorough  acquaintance 
with  the  entire  subject  has  proved  that  there  are  other 
causes  that  are  the  mainspring  of  this,  sometimes  very  se- 
rious accident. 

Indeed,  the  opposite  view  is  now  entertained  by  the  pro- 
fession; that  is,  that  prompt  delivery  by  forceps  will  prevent 
the  parts  from  being  injured,  when  the  soft  parts,  and  par- 
ticularly the  bladder,  is  under  severe  and  prolonged  pressure 
by  the  child's  head.  There  is  no  question  that  there  is 
greater  peril  to  the  mother  and  child,  in  undecisive  delay, 
provided  the  attendant  has  the  requisite  judgment  and  ex- 
perience to  act  intelligently. 

The  hypothesis  upon  which  this  is  based  is  the  restora- 
tive property  that  living  tissue  possesses,  to  regain  its  vi- 
tality, after  it  has  been  subjected  to  severe  and  inordinate 
pressure.  This  we  may  observe  in  our  daily  experience; 
when,  for  instance,  we  jamb  or  crush  our  finger,  or  a  child 
has  its  fingers  momentarily  crushed  between  a  closing  door, 
the  fingers  are  sometimes  crushed  flat,  but  upon  being  re- 
leased, they  rapidly  regain  their  shape  and  vitality.  If  the 
pressure  were  continued  for  any  length  of  time,  the  blood  in 
the  tissues  would  have  become  congealed,  and  the  circula- 
tion permanently  shut  off,  so  that  recuperation  would  have 
been  impossible,  and  the  tissues  would  have  sloughed  or 
mortified. 

If  the  bladder,  under  the  direct  pressure  of  the  child's 
head   against  the   pubic  bone,  be  subjected   too   long,  the 


DISEASES   OF   THE   BLADDER.  171 

same  results  would  naturally  follow :  the  tissues  could  not 
regain  their  vitality,  and  they  would  either  tear  or  subse- 
quently slough  or  mortify,  which  causes  the  fistula. 

The  vagina  and  bladder,  like  every  other  tissue  of  the 
body,  except  that  of  the  brain  or  nerves,  will  suffer  a  great 
deal  of  contusion  for  a  short  time,  but  if  protracted  beyond 
a  reasonable  length  of  time,  it  will  be  permanently  destroyed 
or  injured. 

A  urinary  fistula  is  always  a  serious  malady,  since  it  ex- 
ercises a  deleterious  influence  upon  the  patient's  health.  If 
the  opening  is  only  small,  a  spontaneous  cure  may  take 
place,  but  if  it  reaches  considerable  dimensions,  it  requires 
to  be  accurately  adapted  and  stitched  together.  The  best 
time  for  the  repair  of  the  injury,  is  six  to  eight  weeks  after 
the  receipt  of  the  injury. 

Rupture  of  the  female  bladder  is  comparatively  rare, 
for  the  reason  that  women  are  not  exposed  to  the  same  seri- 
ous accidents  as  men;  but  if  women  will  persist  in  doing 
everything  that  men  ought  to  do  for  them,  the  statistics  may 
be  reversed.  When  the  bladder  is  distended  and  violence  is 
brought  to  bear  on  the  abdominal  walls,  corresponding  to 
the  region  of  the  filled  bladder,  a  rupture  is  likely  to  result. 
Surgical  measures  should  at  once  be  resorted  to,  so  that  the 
injury  can  be  repaired  before  inflammation  of  the  perito- 
neum sets  in. 


CHAPTER  XIII. 

ACUTE  AND    CHRONIC   INFLAMMATION    OF    THE 

VAGINA. 

When  speaking  of  inflammation  of  the  vagina,  reference 
is  had  to  its  mucous  lining  alone.  It  undoubtedly  happens 
that  structures  or  tissues  beneath  the  mucous  covering  be- 
come involved  in  the  inflammatory  action,  but  this  occurs 
so  seldom  that  it  is  not  of  sufficient  moment  to  make  it  the 
subject  of  an  inquiry  in  a  practical  work. 

The  mucous  membrane  of  the  vagina,  like  all  other 
mucous  surfaces,  has  its  natural  secretion  for  the  purpose  of 
lubricating  and  keeping  its  surface  moist.  In  a  perfectly 
healthy  state,  the  color  of  the  vaginal  mucous  membrane  is 
a  pale  red,  this  becomes  scarlet  red  upon  irritation.  In  girls 
who  are  not  irritated  or  women  who  have  not  been  abused 
by  sexual  excesses  nor  infected  by  disease,  the  normal  secre- 
tion is  just  sufficient  to  preserve  the  moisture  of  its  surfaces, 
but  not  in  such  an  excess  as  to  be  noticed  as  a  secretion 
or  discharge  outside  of  the  vaginal  canal.  There  is  a  phys- 
iological exception  to  this  normal  rule,  a  few  days  before 
and  after  the  menstrual  period,  when  the  mucous  membrane 
of  the  vagina  sympathizes  with  the  general  congestion  of 
the  pelvic  organs.  The  mucous  secretion  becomes  then 
greatly  increased,  amounting  to  a  catarrh  or  flow,  this,  how- 
ever, is  only  transient  and  subsides  with  the  cessation  of 
the  menses.  This  might  with  propriety  be  termed  a  natural 
or  physiological  catarrh. 

For  convenience  of  description  and  corresponding  with 
the  anatomical  changes  and  the  sources  of  their  origin,  in- 
flammation of  the  mucous  membrane  of  the  vagina  may 
be  acute  or  chronic,  simple  or  specific. 
(172) 


INFLAMMATION   OF   THE   VAGINA.  173 

Acute  inflammation  in  this  instance  is  no  different  in  its 
characteristic  symptoms  from  inflammations  elsewhere;  it 
develops  suddenly,  and  there  is  congestive  swelling  and 
pain.  There  is  considerable  heat  in  the  parts,  increased  red- 
ness, and  the  canal  is  very  sensitive.  In  the  beginning  the 
mucous  membrane  is  dry  and  contracted,  but  after  a  few 
hours  or  a  day,  relaxation  and  moisture  supersede.  The 
secretion  is  very  scant  at  first,  but  becomes  more  abundant 
as  the  disease  progresses,  its  character  also  changes  from  a 
white,  glairy  mucus  to  a  creamy,  muco-purulent  or  yellowish 
discharge.  The  urethra  may  also  become  involved,  and  then 
the  symptoms  that  were  detailed  in  connection  with  urethritis 
are  also  present. 

Acute  vaginitis  may  arise  from  a  great  variety  of  causes, 
but  the  worst  case  that  ever  came  under  my  notice  was  the 
scalding  effect  of  a  hot-water  injection,  given  under  the  ad- 
vice of  a  physician  who  had  ordered  the  patient  to  use  the 
water  "as  hot  as  she  could  stand  it,"  and  also  told  her  "the 
hotter  the  better."  This  profoundly  wise  suggestion  was 
carried  out  by  the  patient  with  a  vengeance,  for  she  used 
nearly  boiling  hot  water,  which  she  had  tested  by  putting  in 
her  finger  and  quickly  withdrawing  it.  The  steaming  fluid 
so  scalded  the  vagina  that  a  most  pronounced  acute  inflam- 
mation of  the  vagina  was  the  immediate  result.  I  have  had 
other  cases  of  the  chronic  form  come  under  my  notice  that 
were  aggravated  by  similar  advice,  so  that  a  word  of  warning 
against  the  thoughtless  and  indiscriminate  use  of  hot-water 
injections  will  not  be  without  value. 

The  vaginal  irrigations  of  hot  water,  as  a  general  stimu- 
lant to  the  mucous  surfaces,  or  as  an  alterative  to  stimulate 
the  absorbents  to  increased  activity  in  removing  old  pelvic 
exudations,  deserve  a  recognized  place  as  a  useful  therapeu- 
tic measure,  often  of  the  greatest  value,  but  too  hot  or  "as 
hot  as  the  patient  can  bear  it,"  is  superlative  nonsense  and 
absolutely  injurious. 

No  water  injections  into  the  vagina  that  are  kept  up  any 


174  HOME   TREATMENT. 

length  of  time  should  be  warmer  than  110  degrees  Fahr. 
and  never  should  vaginal  injections  be  employed  without 
using  a  thermometer  to  gauge  the  heat.  "When  the  solution 
is  medicated,  103  degrees  should  be  the  average  temperature, 
but  it  should  never  exceed  107  degrees  Fahr.  Exposure  to 
cold  and  moisture  especially  during  the  menses  is  promi- 
nent among  the  causes  of  acute  vaginitis ;  injury  from  pes- 
saries or  coition,  retained  putrefying  secretions  in  the  vagina, 
or  the  application  of  chemical  preparations,  or  injury  during 
confinement,  will  all  induce  this  disease.  Prolonged  nursing 
causes  anaemia,  which  predisposes  the  system  to  catarrhs. 
During  the  child-bearing  period  catarrhs  of  the  vagina  are 
quite  common,  and  excessive  coition  excites  a  very  painful 
inflammation  of  the  vaginal  mucous  membrane. 

Gonorrhoeal  infection  arising  from  a  specific  contagion 
gives  rise  to  a  very  painful  and  dangerous  vaginitis.  The 
character  and  nature  of  the  specific  virus  admits  of  no  par- 
ticular description,  because  its  infectious  quality  of  a  specific 
nature  does  not  at  all  depend  upon  the  physical  appearance 
of  the  infectious  discharge  from  the  male.  Whether*  it  is 
yellow  or  greenish,  muco-purulent  or  a  glairy  mucous  dis- 
charge, establishes  no  criterion,  but  the  presence  of  microbes, 
the  gonococcus  of  Neisser;  this,  of  course,  a  careful  micro- 
scopic examination  can  alone  establish.  This  much  is  true, 
that  careful  researches  in  Europe,  by  competent  and  reliable 
authorities,  have  established  the  fact,  from  carefully-prepared 
statistics,  that  this  is  a  far  more  fruitful  source  of  uterine 
diseases  than  was  formerly  dreamed  of. 

A  specific  vaginitis  has  a  greater  tendency  to  spread  it- 
self along  the  mucous  tract  of  the  genital  organs  of  the  fe- 
male than  a  simple  non-specific  catarrh.  In  the  former  the 
womb  and  Fallopian  tubes  become  successively  affected,  as 
we  shall  learn  more  definitely  when  we  have  occasion  to  in- 
quire into  the  diseases  peculiar  to  these  organs. 

Acute  inflammation  of  the  vagina  has  pronounced  symp- 
toms, and  when  any  one  of  them  is  felt  by  the  patient,  she 
should  lose  no  time  in  resorting  to  treatment. 


INFLAMMATION   OF   THE   VAGINA.  175 

The  first  symptom  that  is  generally  perceived  by  the 
patient  is  a  sense  of  heat  and  burning  in  the  vaginal  canal; 
this  is  also  reflected  in  the  neck  of  the  bladder  during  mic- 
turition. As  the  disease  develops,  there  is  a  constant  desire 
to  pass  water  frequently,  and  this  becomes  sometimes  a 
prominent  sign.  A  dull  aching  weight  is  felt  between  the 
vagina  and  rectum.  After  these  have  lasted  for  some  days, 
an  offensive  discharge  from  the  vagina  ushers  in  the  second 
stage,  excoriating  the  skin  around  the  vulva,  and  if  the  dis- 
ease should  spread  itself  to  the  neighboring  organs,  there  is 
a  violent  throbbing  pain  in  the  whole  pelvis. 

Women  who  are  suffering  with  acute  painful  vaginitis 
should  take  to  bed;  all  pelvic  diseases  of  any  acuteness  at 
all  are  treated  at  a  great  disadvantage  when  the  patient  is 
running  around  and  on  her  feet.  The  disturbance  in  the 
circulation,  the  exposure  to  cold  from  cold  floors  or  damp  side- 
walks, and  the  impossibility  of  preserving  an  equable  tem- 
perature of  the  body,  when  out  of  bed,  only  aggravate  the 
malady. 

The  vagina  is  to  be  douched  several  times  a  day  with 
half  gallon  of  warm  water,  in  which  a  half  teaspoonful  or 
one  tablet  of  Femina  antiseptic  uterine  lotion  has  been  dis- 
solved, and  when  the  canal  is  rinsed,  a  Femina  vaginal  cap- 
sule should  be  introduced,  but  only  once  a  day,  and  that  is 
preferable  at  bedtime.  The  feet  and  extremities  should  be 
kept  warm,  and  in  married  women  total  continence  should 
be  observed  while  the  slightest  irritation  and  soreness  exists. 
By  the  non-observance  of  this  precaution,  the  best  directed 
efforts  will  often  be  frustrated  and  many  female  diseases 
which  are  readily  curable  in  the  beginning  become  chronic, 
and  a  moment's  reflection  ought  to  make  this  clear  to  any 
person  of  ordinary  intelligence. 

If  there  is  the  slightest  suspicion  that  the  disease  is  of  a 
specific  nature,  the  treatment  must  be  antiseptic  in  its  na- 
ture. Your  physician  should  be  reminded  of  the  possible 
nature  of  the  disease,  for  doctors  as  a  rule  are  ignorant  of 
the  dangers  that  ordinarily  accompany  gonorrhoeal  infection. 


176  HOME    TREATMENT. 

Oppenheimer  in  Germany  made  experiments  for  testing 
the  germicidal  properties  of  various  drugs  on  the  specific 
germs  of  gonorrhoea,  and  he  proved  that  a  corrosive  subli- 
mate solution  of  1  part  to  20,000  will  kill  the  gonococci. 
Corrosive  sublimate  is  the  corrosive  chloride  of  mercury, 
one  of  the  most  powerful  of  the  mineral  poisons,  and  while 
it  is  perfectly  safe  in  the  dilutions  that  it  is  employed  in,  the 
greatest  precaution  must  be  constantly  exercised  to  keep  the 
drug  isolated  and  out  of  the  reach  of  children,  especially 
the  "antiseptic  tablets,"  of  which  mention  will  be  made  be- 
low, because  little  children  and  adults  also  might  at  first 
sight  believe  that  they  were  candy. 

I  am  accustomed  to  employ  the  corrosive  sublimate  much 
stronger  than  the  Oppenheimer  experiments  demand,  a  prac- 
tice which  I  base  upon  practical  observations,  while  in  the 
Berlin  clinics,  and  that  is  in  the  proportion  of  1  to  2,000. 
John  Wyeth  &  Bro.,  of  Philadelphia,  and  other  manufactur- 
ing chemists,  make  compressed  tablets  or  wafers,  which  are 
very  convenient  and  easily  handled  by  any  person  of  average 
understanding.  These  are  sold  by  the  druggists  in  little  wide- 
mouth  bottles,  properly  labeled,  so  that  the  required  strength, 
1  to  2,000,  is  obtained  by  dissolving  one  or  two  according  to 
their  strength  in  a  half  gallon  of  warm  water.  Whenever 
gonorrhoea  is  suspected,  the  vagina  should  be  thoroughly 
rinsed  out  several  times  a  day  with  the  corrosive  solution. 
If  the  patient  fears  mercurial  poisoning,  the  antiseptic  irriga- 
tion can  be  followed  by  plain  warm-water  rinsings  as  a  safe 
precaution  against  mercurial  absorption. 

CHRONIC    CATARRH,    LEUCORRHCEA    OR   WHITES. 

An  acute*'  inflammation  of  the  mucous  membrane  of  any 
organ  may  drift  into  the  chronic  or  subacute  form,  so  that 
any  of  the  causes  which  give  rise  to  the  acute  variety  are 
among  those  that  are  to  be  looked  for  in  chronic  catarrh. 
The  general  characteristics  of  catarrh  are  the  same,  whether 
acute  or  chronic  or  whether  located  in  the  nose,   throat, 


INFLAMMATION   OF   THE   VAGINA.  177 

bronchial  tubes  or  vagina.  This  fact  greatly  simplifies  the 
whole  subject  of  catarrhal  inflammations,  so  that  the  gen- 
eral reader  will  find  no  difficulty  in  acquiring  the  necessary 
information  for  successful  home  treatment  of  this  very 
common  class  of  diseases. 

Chronic  vaginal  catarrh  has  been  divided  into  two  va- 
rieties, vaginal  and  uterine.  The  distinction  depends  upon  its 
origin  or  complication.  Vaginal  catarrh  has  its  origin  in 
and  is  limited  to  the  vaginal  canal.  I  have  already  called 
attention  to  a  purely  physiological  catarrh  that  accompanies 
the  menstrual  flow  and  which  subsides  with  the  cessation  of 
the  menses ;  in  addition  to  this,  there  is  probably  no  woman 
who  goes  through  life  without  at  some  time  during  her  nat- 
ural existence  having  this  disease  or  symptom.  Often  the 
discharge  is  so  scant  that  it  entirely  escapes  her  notice,  and 
not  until  it  becomes  annoying  by  its  constancy  and  abun- 
dance do  women  seek  assistance. 

In  ancient  times  and  until  quite  recently,  it  was  consid- 
ered as  a  distinct  disease,  attributed  to  constitutional  debil- 
ity or  an  indication  of  impure  blood;  these  theories  are 
now  entirely  discarded.  The  modern  school  of  Gynecology 
has  given  it  quite  a  different  interpretation,  and  considers 
leucorrhcea  rather  a  symptom  of  some  local  disease  than  a 
disease  itself.  Experience,  and  careful  research  in,  the  sick 
chamber  fully  corroborate  the  correctness  of  this  view,  so 
that  a  simple  local  chronic  catarrh  is  the  exception  to  the 
rule.  The  exception  applies  oftener  to  children  than  to 
adults.  We  find  it  in  young  babies  or  little  girls  of  all  ages 
as  a  result  of  diarrhceal  discharges  which  are  acrid  and 
filter  themselves  into  the  vagina  and  by  their  sharp,  irrita- 
ting action  on  the  mucous  membrane,  excite  at  first  an 
acute,  and  afterwards  a  chronic  catarrh  of  these  parts. 
Eruptive  fevers  have  induced  a  similar  effect  upon  the  mu- 
cous membrane  of  the  child's  vagina  and  also  upon  that 
of  the  bladder;  obstinate  catarrhs  are  frequently  traced  to 
these  fevers.  I  have  known  pinworms  to  make  their  way 
12 


178  HOME   TREATMENT. 

from  the  rectum  into  the  vagina  and  by  their  irritating 
presence  excite  in  the  little  child  a  very  distressing  vaginal 
catarrh. 

The  irritation  or  itching  which  the  inflammation  and 
decomposed  secretion  cause,  makes  the  child  involuntarily 
dig  or  scratch  her  vulva,  which  of  course  only  aggravates 
the  disease,  and  which  has  already  been  mistaken  for  pre- 
cocious masturbation,  and  will  undoubtedly  often  be  so  con- 
sidered again  by  superficial  observers.  In  later  years  a 
subacute  inflammation  of  these  parts  will  undoubtedly  de- 
velop this  pernicious  practice,  and  I  have  known  several 
cases  myself  where  young  girls  became  physical  wrecks 
from  a  combination  of  chronic  vaginal  catarrh  and  self- 
abuse,  no  one  ever  dreaming  of  the  real  morbid  condition, 
but  attributing  their  decline  to  everything  else  but  the 
right  cause. 

There  is  another  complication  that  may  arise  from  ca- 
tarrhal inflammation  in  little  children,  and  that  is  an  ad- 
hesive inflammation  of  the  vaginal  walls ;  that  means  that 
the  sides  of  the  vagina  may  partly  or  completely  grow  to- 
gether, and  thus  change  the  normal  diameter  of  the  vaginal 
canal.  In  after  years  this  may  entail  frightful  suffering, 
either  by  mechanically  obstructing  the  escape  of  the  men- 
strual blood  or  otherwise  interfering  with  the  normal  func- 
tion of  the  canal.  There  are  many  diseases  from  which  we 
suffer  in  adult  life  for  which  the  foundation  was  laid  when 
we  were  young,  through  the  ignorance  of  our  parents. 

The  stormy  symptoms  that  usher  in  the  acute  form  are 
absent  in  the  development  of  the  subacute  or  chronic  vari- 
ety. This  disease  begins  sometimes  so  insidiously  that  the 
patient  may  not  be  aware  of  its  existence  for  quite  a  while. 
The  secretion  may  not  be  at  first  changed  in  its  character, 
save  that  it  is  noticed  in  greater  abundance.  In  the  course 
of  time,  the  nature  of  the  secretion  will  be  greatly  changed, 
from  a  white  glairy  discharge  into  a  grayish  opaque  se- 
cretion ;  this  will  be  tinged  greenish  some  days  and  be  of  a 


INFLAMMATION   OF   THE   VAGINA.  179 

rnuco-purulent  aspect.  In  the  great  majority  of  cases  it  is  a 
whitish  cheesy  discharge  from  which  the  names  leucorrhcea 
or  whites  have  been  derived. 

The  color  of  the  vaginal  mucous  membrane  in  chronic 
-catarrh  is  of  a  bluish  red  tint,  and  its  surface  presents  in 
places  granulated  patches,  that  bleed  easily  when  they  are 
touched.  The  vaginal  walls  are  relaxed,  so  that  women 
often  complain  that  they  have  a  sensation  of  "feeling  open;  " 
this  is  indeed  the  real  state  of  affairs;  the  walls  of  the 
vagina  may  become  so  relaxed  as  to  constitute  a  prolapse 
of  the  anterior  portion  or  wall  of  the  vagina,  dragging  the 
bladder  and  womb  down  with  it. 

A  great  many  of  the  so-called  "falling  of  the  womb  cases" 
are  no  falling  of  the  womb  at  all  but  simply  a  relaxed  va- 
gina, in  which  the  wearing  of  pessaries  or  any  other  me- 
chanical uterine  supporter  will  actually  do  a  great  deal  of 
harm. 

The  treatment  of  vaginal  catarrh  is  principally  local, 
when  there  are  no  constitutional  complications.  Of  course 
there  are  rules  of  conduct  that  apply  to  all  catarrhal  pa- 
tients, whether  the  catarrh  is  of  the  genitalia,  of  the  nose  or 
throat  or  of  the  bronchial  tubes;  these  rules  constitute  the 
hygiene  of  catarrh,  a  subject  which  is  discussed  in  a  separate 
chapter  in  this  work  to  which  the  intelligent  reader  is  re- 
ferred. 

The  main  feature  of  the  treatment  consists  in  thorough 
cleanliness  of  the  vaginal  canal  and  in  the  use  of  a  soothing 
lotion.  This  object  is  best  accomplished  by  the  use  of  the 
Femina  antiseptic  lotion  and  in  the  following  manner:  Dis- 
solve one  tablet  or  half  a  teaspoonful  in  a  cupful  of  hot  wa- 
ter and  then  add  this  to  a  half  gallon  of  warm  water  of  a 
temperature  of  103°  F.,  and  by  means  of  an  elastic  bulb  syr- 
inge, use  the  entire  quantity  at  one  time.  If  the  discharge  is 
profuse,  or  if  any  offensive  odor  is  perceptible,  then  the  vag- 
inal injection  should  be  made  several  times  a  day. 


180  HOME   TREATMENT. 

In  case  there  is  soreness  and  pain  in  the  pelvis,  and 
there  generally  is,  a  Femina  vaginal  capsule  should  be  in- 
troduced into  the  vagina,  just  before  retiring. 

When  the  patient  feels  a  dragging  sensation,  or  such 
symptoms  as  would  indicate  a  prolapse  (falling  down)  of 
the  vaginal  walls  from  weakness  or  relaxation  of  the  col- 
umns and  muscular  tissue  which  give  them  support,  then 
the  Femina  antiseptic  uterine  lotion  should  be  used,  as. 
before  described,  with  this  difference,  that  double  the  quan- 
tity should  be  dissolved  in  the  cupful  of  hot  water,  and  then 
added  to  the  half  gallon  of  warm  water  of  the  same  tem- 
perature and  used  in  the  same  manner.  When  the  Femina 
antiseptic  uterine  lotion  is  used  in  its  double  strength,  the 
remedy  loses  nothing  in  its  healing  effect  but  becomes  more 
astringent,  strengthening,  and  disinfectant. 

Be  sure  that  the  nozzle  of  the  syringe  sweeps  the  entire 
vaginal  cavity,  and  if  the  above  quantity  of  fluid  should 
not  be  sufficient  to  thoroughly  cleanse  the  vagina,  then  use 
double  the  quantity  of  fluid. 

With  this  prescription  I  have  cured  cases  of  leucorrhosa 
of  twenty  years'  standing  which  had  gone  through  the  ordeal 
of  all  the  different  treatments  that  they  were  capable  of  un- 
dergoing. 

I  would  recommend  to  those  patients  who  feel  their 
wombs  dragged  down,  the  knee-chest  posture,  that  means,  to 
kneel  down  on  the  floor  with  the  hips  elevated  as  high  as 
possible  and  the  chest  close  down  to  the  floor.  This  position 
rolls  the  abdominal  organs  upwards  and  forwards,  and  thus 
naturally  draws  the  womb  and  vagina  into  their  normal 
positions,  much  better  than  any  mechanical  appliance  or 
operator  can  possibly  accomplish  it.  It  simply  allows  the 
relaxed  organs,  through  the  natural  law  of  gravitation,  to 
gravitate  where  they  belong.  It  is  necessary  to  retain  this 
kneeling  position  for  only  ten  or  fifteen  minutes,  repeated 
twice  a  day,  say  night  and  morning,  and  the  curative  effect 
is  truly  wonderful. 


INFLAMMATION   OF   THE   VAGINA.  181 

When  I  speak  of  the  curative  measures  of  displacements 
in  general  and  of  falling  of  the  womb  downwards  and  back- 
wards in  particular,  I  will  give  a  detailed  description  of  the 
knee-chest  position. 

There  should  be  a  choice  in  selecting  a  vaginal  syringe 
or  a  syringe  for  vaginal  bathing.  The  "fountain  syringe" 
has  several  objections  that  are  insurmountable.  In  the  first 
place,  the  quantity  of  fluid  that  is  to  be  used  is  limited  by 
the  capacity  of  the  reservoir,  or  in  order  to  replenish  it,  the 
even  tenor  of  the  rinsing  is  disturbed.  Another  objection 
is,  that  the  convenient  peg  upon  which  to  hang  it  is  not 
always  present,  or  a  shelf  upon  which  to  rest  it  not  high 
enough ;  then  there  is  not  the  control  over  the  stream  that 
is  desirable,  so  that  considerable  confusion  arises  at  times 
from  the  fluid  wetting  things  that  had  better  be  kept  dry. 
For  these  reasons  I  prefer  a  bulb  syringe. 


CHAPTER  XIV. 

HYGIENIC  MEASURES  FOR  CATARRHAL  DISEASES 
OF  THE  FEMALE  ORGANS. 

No  treatment  for  catarrhal  inflammations  in  general  and 
of  the  pelvic  organs  in  particular  is  certain  and  complete 
without  special  attention  being  given  to  certain  laws  or  rules 
that  are  laid  down  for  the  preservation  and  attainment  of 
health,  and  these  comprise  one  of  the  collateral  departments 
of  medical  science  which  is  termed  hygiene. 

What  the  skin  or  integument  is  to  the  exterior  of  the 
body,  the  mucous  membrane  which  lines  the  respiratory 
passages  and  other  organs  is  to  the  interior  of  the  body. 

The  mucous  membrane  is  only  a  modification  of  the 
skin,  and  while  it  differs  in  its  glandular  composition  in  the 
different  organs  that  it  lines,  in  the  main,  it  retains  the  com- 
mon characteristics  of  the  skin  or  outer  covering  of  the 
body. 

The  corium  or  fibrous  layer  of  the  mucous  membrane  is 
analagous  to  the  derma  of  the  skin ;  and  it  is  in  fact  a  con- 
tinuation of  it  at  the  orifices  of  the  body. 

The  corium  of  the  mucous  membrane  supports  an  epi- 
thelial layer  of  cells  that  are  of  various  forms,  differing  in 
the  different  organs  that  it  lines. 

Underneath  the  corium  of  the  mucous  membrane  there 
is  the  fibro-vascular  layer,  which  contains  the  blood  vessels, 
lymphatics  and  nerves  and  embedded  in  the  epithelial  cells 
supported  by  the  corium  are  the  numerous  mucous  glands 
or  follicles.  In  some  portions  of  the  mucous  tract  and  pro- 
jecting out  of  it  are  little  elevations  called  villi  or  papillae, 
analogous  to  the  papillae  of  the  skin. 

(182) 


HYGIENIC   MEASURES.  183 

These  glands  and  papillae  exist  only  at  certain  parts  and 
are  modified  according  to  the  function  that  the  organ  per- 
forms. The  mucous  glands  of  the  stomach  differ  from  those 
of  the  intestines,  and  those  of  the  mouth  from  those  of  the 
bronchial  tubes.  The  mucous  membrane  of  the  womb  dif- 
fers from  all  the  rest,  by  having  no  submucous  or  fibro- 
vascular  layer ;  the  mucous  glands  of  the  womb  are  im- 
bedded and  extend  directly  into  the  muscular  tissue  of  the 
organ.  The  secreting  glands,  which  form  a  special  feature  of 
mucous  membranes,  are  abundantly  supplied  by  small  capil- 
lary blood  vessels  and  nerves,  so  that  any  disturbance  of  the 
general  or  systemic  circulation  or  a  derangement  of  the 
nervous  system  will  at  once  greatly  influence  the  healthy  or 
normal  secretion  of  the  membrane,  just  exactly  as  the  skin 
is  affected  by  cold  or  fright. 

In  order  to  appreciate  all  the  causes  that  operate  for 
either  good  or  evil,  we  must  pause  for  a  moment  and  con- 
sider the  sympathy  with  and  the  close  relation  of  the  mucous 
membrane  to  the  circulation  of  the  blood  and  the  nervous  sys- 
tem. The  mucous  membrane  of  the  different  organs  is  often 
made  the  safety  valve  through  which  obnoxious  materials 
or  morbid  conditions  of  the  blood  are  eliminated  from  the 
system,  and  for  that  reason  I  have  long  ago  discarded  the 
usual  harsh  measures  in  the  treatment  of  sudden  or  acute 
catarrhs.  I  have  found  that,  by  carefully  watching  and 
giving  close  attention  to  the  details  of  certain  rules  of  health, 
catarrhs  speedily  disappear  of  their  own  accord :  on  the 
other  hand,  if  irritating  local  remedies  are  constantly  used, 
catarrhs  continue  to  grow  worse. 

This  demonstrated  fact  so  very  often  repeated,  impressed 
upon  my  mind  the  importance  of  hygienic  measures  for  the 
successful  treatment  of  catarrhal  inflammations,  whether 
they  are  of  the  respiratory  organs  or  of  the  female  pelvic  or- 
gans. The  most  prominent  and  efficacious  measures  are  to 
be  found  in  intelligent  precautions  for  preventing  colds  and 
inuring  the  system  to  changes  of  temperature  by  appropriate 
outdoor  exercise. 


184  HOME   TREATMENT. 

By  far  the  greater  proportion  of  female  complaints  are 
catarrhal  inflammations,  and  these  fasten  themselves  upon 
all  the  pelvic  organs — on  the  bladder,  vagina,  womb  and 
Fallopian  tubes. 

We  generally  know  how  we  contract  a  bronchial  catarrh 
or  bronchitis,  a  nasal  catarrh  or  sore  throat ;  in  precisely  the 
same  manner  do  women  contract  most  of  their  pelvic  ca- 
tarrhs, that  is,  from  a  common  cold  or  sudden  chilling  of 
the  body  or  part  of  the  body. 

Dr.  Thomas  F.  Rumbold,  in  his  work  on  the  "Hygiene 
and  Treatment  of  Catarrh,"  says  :  "  The  history  of  every  case 
of  chronic  catarrh  attests  that  the  complaint  commenced 
with  colds  in  the  head  and  that  the  disease  grew  upon  the 
patient  almost  imperceptibly,  the  first  colds  being  so  trivial 
in  character  as  to  attract  but  little  attention." 

This  statement  is  as  true  of  the  great  majority  of  cases  of 
vaginal  and  uterine  catarrh  as  it  is  of  catarrhs  of  the  air 
passages,  and  for  this  reason  the  measures  and  precautions 
for  the  prevention  of  colds  must  be  one  of  the  features  in  the 
successful  treatment  of  female  complaints. 

The  particulars  of  the  causation  of  colds  and  the  hy- 
gienic precautions  for  their  prevention  are  hardly  ever  given 
the  attention  which  their  importance  demands  in  the  treat- 
ment for  catarrhal  complaints  of  women,  so  that  a  great 
deal  of  suffering  is  left  unrelieved  and  a  great  deal  of  ex- 
pensive and  useless  doctoring  is  endured.  Altogether  too 
much  reliance  is  placed  upon  a  wash  or  some  local  appli- 
cation made  by  the  doctor  to  the  affected  parts,  and,  indeed, 
the  mainspring  of  the  catarrhal  affection  is  entirely  over- 
looked or  neglected,  which  is,  the  susceptibility  to  the  re- 
currence of  fresh  colds. 

The  injurious  effects  of  taking  cold  or  chilling  the  body 
or  any  part  of  it,  have  been  the  subject  of  special  inquiry  in 
Germany.  The  mucous  membrane  and  the  skin  seem  the 
most  sensitive  to  sudden  changes  from  a  warm  to  a  colder 
atmosphere,  but  observations  have  already  proven  that  be- 


HYGIENIC  MEASURES.  185 

sides  the  usual  catarrhal  inflammations,  there  are  other  in- 
flammatory conditions  that  are  developed.  The  kidneys, 
lungs,  and  liver  have  been  found  to  be  the  seat  of  inflam- 
mations in  a  series  of  experiments  that  were  made  with  rab- 
bits that  were  removed  from  a  warm  to  a  much  colder 
apartment,  and  from  this  may  be  inferred  that  these  condi- 
tions originate  similarly  in  the  human  subject. 

The  logical  conclusions  of  these  researches  have  been, 
that  the  chilled  or  cooled  blood  becomes  chemically  altered 
and  acts  as  a  direct  irritant  in  the  small  capillary  vessels, 
and  by  that  means  all  the  phenomena  of  inflammation  of 
the  tissues  are  excited,  and  these  of  course  develop  wherever 
the  cold  may  strike  or  locate. 

When  we  speak  of  a  slight  or  a  bad  cold,  we  cannot 
form  the  least  idea  of  the  remote  effects  that  the  cold  may 
bring  about.  It  may  lay  the  foundation  of  a  nephritis  or 
Bright's  disease  of  the  kidneys,  or  some  other  lesion,  and 
that  it  often  gives  rise  to  vaginal  and  uterine  catarrh  is  as 
certain  as  that  it  gives  rise  to  nasal  catarrh  or  a  cold  in  the 
head. 

An  aptitude  to  take  cold  grows  with  each  repetition  of 
the  attack  and  the  prolonged  duration  of  the  acute  catarrhal 
symptoms.  And  for  that  reason  persons  grow  into  the  habit 
of  taking  cold  upon  the  slightest  exposure  or  change  of 
temperature.  At  this  stage  of  catarrh  there  is  an  abnormal 
sensitiveness  of  the  mucous  membrane  and  skin,  in  which 
the  slightest  draught  of  air  or  even  passing  from  one  room 
to  another  occasions  an  attack  of  sneezing  or  a  chill  and 
other  symptoms  that  will  indispose  the  patient  for  several 
days. 

The  great  majority  of  individuals  have  a  natural  predis- 
position to  certain  diseases. 

In  anatomy  the  body  has  been  divided  into  systems.  A 
system  is  an  assemblage  of  organs  composed  of  the  same 
tissues  and  intended  for  similar  functions,  as  the  circulatory 
system,  the  nervous  system,  the  muscular  system,  the  cuta- 


186  HOME   TREATMENT. 

neous  system,  etc.;  these  systems  are  all  liable  to  particular 
diseases.  In  one  person  the  mucous  membrane  of  the  respi- 
ratory system  is  the  most  sensitive  part  of  the  body,  while 
in  another,  and  especially  in  women,  it  is  the  mucous  mem- 
brane of  the  genito-urinary  system.  In  other  words,  one 
person  will  take  a  cold  and  it  will  settle  in  the  head  or  on 
the  bronchial  tubes,  while  another  from  the  same  exposure 
will  get  a  catarrhal  inflammation  of  the  bladder  or  womb ; 
this  is  only  explained  on  the  theory  of  natural  predisposi- 
tions, and,  perhaps,  hereditary  taints. 

If  a  person  once  knows  the  weak  or  vulnerable  points, 
he  can  outgrow  them,  by  employing  such  rules  of  hygiene 
as  experience  has  taught  to  be  useful.  There  is  much  more 
benefit  to  be  derived  in  an  educational  treatment  directed 
to  the  prevention  of  disease,  for  this  is  also  in  the  nature  of 
a  cure,  than  in  a  blind  obedient  faith  in  the  treatment  or 
remedy  of  a  physician  who  may  be  ignorant,  and  generally 
is,  of  the  laws  of  health  or  the  science  of  hygiene. 

To  promote  health  and  to  antagonize  disease  is  greatly 
within  one's  own  power,  because  there  is  no  doubt  that  most 
diseases  are  the  result  of  imprudence  that  cannot  be  attrib- 
uted to  ignorance,  because  persons  commit  these  errors  with 
a  full  knowledge  of  their  evil  effects. 

A  healthy  habitation,  that  has  all  the  advantages  of  pure 
air  and  sunshine,  is  an  essential  feature  in  regaining  health 
and  encouraging  a  cure.  There  are  hundreds  of  persons 
who  have  been  sick  and  miserable  for  years,  and  who  have 
made  the  rounds  of  all  the  doctors  they  ever  heard  of,  with- 
out the  least  benefit  to  themselves,  because  they  were  never 
told  how  to  live,  and  their  living  rooms  are  dark  and  sun- 
less and  poorly  ventilated. 

The  even  and  equable  temperature  of  all  the  rooms  of  a 
house  should  be  kept  in  constant  view,  so  that  sudden  and 
extreme  changes  of  temperature  are  avoided. 

Warming  a  dwelling  artificially  should  be  one  of  the 
important  features  in  the  construction  of  a  completely-fur- 


HYGIENIC    MEASURES.  187 

nished  residence.  This  subject  has  been  neglected,  owing 
to  the  temperate  climate  of  California,  yet  the  moisture  of 
the  air,  and  the  closeness  with  which  dwellings  are  built  in 
cities,  exclude  the  rays  of  the  sun  and  make  houses  too  cold 
for  health  and  comfort.  In  our  climate  we  become  more 
sensitive  to  the  cold  air  than  those  who  live  in  drier  regions. 

In  shaded  houses  and  rooms,  especially  in  damp  weather, 
we  need  artificial  heating  as  much  as  they  do  in  colder  cli- 
mates, so  that  architects  should  make  it  a  study  to  introduce 
a  system  of  heating  that  will  insure  an  equable  temperature 
throughout  the  entire  building,  at  a  minimum  of  expense. 

The  fireplace  or  open  hearth,  which  has  become  so  pop- 
ular with  us  as  the  pleasantest  and  healthiest  mode  of  heat- 
ing and  also  insuring  ventilation,  should  be  discarded  for 
something  much  better.  The  fact  that  the  fire  is  directly 
beneath  the  chimney  flue  explains  the  fact  that  eighty-seven 
per  cent  of  the  total  heat  yielded  by  coal  or  coke  and 
ninety-four  per  cent  of  that  yielded  by  wood  escapes  through 
the  chimney.  This  enormous  loss  of  temperature  arises  from 
the  current  of  air  necessary  for  combustion,  carrying  with  it 
a  large  quantity  of  the  heat  produced  which  is  lost  in  the 
atmosphere.  This  of  course  is  a  means  of  ventilation,  but  a 
little  reflection  will  convince  almost  anyone  that  it  cannot 
be  the  most  practical,  and  in  this  State  where  coal  is  very 
high  it  is  equally  expensive.  The  smoke,  soot,  and  ashes 
that  are  inseparable  from  the  open  fireplace  make  it  trouble- 
some and  dirty,  not  to  say  anything  of  the  coal  gas,  which 
poisons  the  atmosphere  of  a  room,  and  I  have  often  noticed 
its  noxious  influence  on  infants. 

There  are  objections  against  warming  one  or  two  rooms 
of  a  house  and  leaving  the  others  cold.  A  warm  sitting 
room,  while  the  halls  and  bedrooms  remain  cold  and  chilly, 
is  a  very  fruitful  source  of  cold  and  catarrhs. 

There  is  a  vast  difference  between  heating  for  health,  and 
heating  to  have  warm  rooms;  in  the  former,  the  warm  rooms 
would  be  incidental  to  health  and  comfort,  while  in  the  latter 
you  might  sacrifice  health  for  warm  rooms. 


188  HOME   TREATMENT. 

Heating  by  hot  air  has  serious  objections  that  may  be 
briefly  stated  as  follows:  Fresh  air  passing  through  or  around 
red  hot  furnaces,  becomes  so  rarefied  that  it  no  longer  con- 
tains sufficient  oxygen  for  healthful  breathing  purposes. 

The  expansion  and  contraction  of  the  furnace  allows  the 
escape  of  the  noxious  gases  of  combustion  which  become 
unavoidably  mixed  with  the  hot  air  that  is  to  heat  the 
dwelling,  and  thus  vitiate  the  air  that  is  to  be  breathed,  and 
should  there  be  any  malaria  from  defective  sewerage  in  the 
basement  that,  too,  would  be  circulated  with  the  heated  air. 

It  seems  also  to  be  impossible  to  distribute  hot  air  equally 
to  all  the  rooms  of  a  house  through  long  flues,  for  the  hot  air 
is  choked  off  at  the  registers  by  the  counter  currents  of  cold 
air  from  the  rooms  on  the  side  of  the  house  exposed  to  the 
winds,  while  the  protected  side  is  always  overheated. 

I  have  practically  demonstrated,  in  my  own  residence, 
that  hot  water  is  the  most  simple  and  efficient  means  of  heat- 
ing a  dwelling  for  both  health  and  comfort,  and  for  several 
reasons:  There  is  no  danger  of  overheating,  and  there  is  no 
possibility  of  vitiating  the  air,  because  the  temperature  of 
the  hot  water  is  always  lower  than  even  the  boiling  point. 

With  a  proper  distribution  of  the  heated  water  through 
pipes,  and  radiators  of  sufficient  heating  surface,  all  rooms 
can  be  warmed  to  an  equal  temperature.  Another  consider- 
ation is  the  economy  in  fuel  when  properly  constructed  heat- 
ers are  used,  for  the  water  readily  absorbs  the  heat  and  re- 
tains it  for  hours  after  the  fire  has  ceased  to  burn.  Unlike 
steam  heating,  a  moderate  fire  will  warm  the  house  in  mod- 
erate weather.  Hot  water  heating  does  not  exclude  a  prac- 
tical scientific  system  of  ventilation.  There  is  no  danger 
from  explosion,  nor  from  fire,  the  plant  is  absolutely  odor- 
less and  noiseless,  and  requires  neither  mechanical  skill  nor 
close  attention  to  run  it.  There  is  no  doubt  of  the  durabil- 
ity of  a  hot  water  system,  for  if  properly  constructed  it 
should  last  as  long  as  the  building,  and  the  cost  is  less  than 
a  number  of  mantels  with  the  necessary  flues. 


HYGIENIC   MEASURES.  189 

The  most  comfortable  average  temperature  for  living 
rooms  is  from  65  to  70  degrees  Fahr.,  for  hospitals  and  sick 
rooms  a  higher  temperature  is  generally  required,  say  from 
75  to  80  degrees  Fahr. 

Dr.  Horace  Dobell,  of  London,  in  his  work  entitled 
"Winter  Cough,"  makes  some  very  practical  and  useful  re- 
marks, when  he  says:  "But  before  leaving  the  subject  of  sud- 
den changes  of  temperature,  I  must  not  forget  to  speak  of 
sleeping  rooms.  It  is  quite  astonishing  what  follies  are 
committed  with  regard  to  the  temperature  of  sleeping  rooms. 
On  what  possible  ground  people  justify  the  sudden  transi- 
tion from  the  hot  sitting  room  to  a  wretched  cold  bedroom, 
which  may  not  have  had  a  fire  in  it  for  weeks  or  months,  it 
is  impossible  to  say,  but  it  is  quite  certain  that  the  absurd 
neglect  of  properly  warming  bedrooms,  is  a  fruitful  source 
of  all  forms  of  catarrh.  We  cannot  too  much  impress  this 
upon  our  patients." 

There  is  another  source  of  danger  in  artificial  heating, 
and  that  is,  in  having  the  air  of  the  house  always  much 
warmer  than  the  most  favored  temperature  of  the  open  air. 
This  is  a  great  mistake  because  it  is  under  these  circum- 
stances almost  impossible  to  go  from  an  overheated  house 
or  apartment  into  the  open  fresh  air  without  catching  cold, 
and  for  this  reason  the  thermometer  should  be  found  in 
every  well-regulated  household.  Women  who  are  under 
treatment  for  female  disease  should  never  get  into  a  cold 
bed,  even  if  there  has  been  fire  in  the  sleeping  room  during 
the  day.  In  damp  and  cold  weather  there  should  be  greater 
precaution  in  this  respect.  The  best  bed  warmer  is  one  or 
more  earthenware  jugs,  like  the  German  seltzer  water  jugs, 
filled  with  hot  water.  Earthenware  radiates  the  heat  better 
and  retains  the  warmth  longer  than  glass,  while  there  is  no 
danger  of  the  heat  cracking  the  jug,  as  it  will  glass  bottles. 
One  or  two  of  these  jugs  filled  with  hot  water  and  put  into  a 
bed  an  hour  or  so  before  retiring  will  bring  the  temperature 
up  to  an  agreeable  warmth. 


190  HOME   TREATMENT. 

Proper  clothing  is  perhaps  from  a  sanitary  standpoint  of 
equal  importance  with  that  of  artificial  heating  and  ventila- 
tion. With  appropriate  clothing,  the  body  can  be  pro- 
tected against  the  inclemency  of  the  weather  and  the  sud- 
den changes  of  the  atmosphere  so  that  no  ill  effects  are 
experienced  from  the  great  changes  of  temperature  to  which 
we  are  exposed.  "Women  are  dressed  less  warmly  than 
men,  although  they  do  not  possess  the  bodily  strength  to  re- 
sist cold  in  the  same  degree  as  men.  Their  garments  are 
not  only  made  of  lighter  material,  but  the  loose,  fluttering 
manner  in  which  they  hang  around  the  limbs  does  not  pro- 
tect their  bodies  in  the  same  thorough  manner  that  similar 
material  made  after  the  style  of  men's  clothing  protects  men. 

This  does  not  imply  that  women  should  don  men's  cloth- 
ing, because  the  present  costume  or  outside  apparel  of 
women  of  civilized  countries,  is  both  graceful  and  modest. 
A  reform,  however,  in  her  underclothing  is  not  only  desir- 
able but  in  many  cases  absolutely  necessary  to  insure  per- 
manent relief  from  catarrhal  affections. 

All  women  who  are  suffering  from  uterine  or  pelvic 
diseases,  and  who  are  still  wedded  to  the  injurious  costume 
of  open  drawers  and  skirts,  have  an  important  lesson  to  learn. 

A  warm  and  complete  covering  for  the  lower  extremities 
and  pelvic  organs  is  paramount  to  any  medicine  or  treatment 
that  can  be  given. 

It  is  during  the  menstrual  period  that  the  pelvic  organs 
are  more  susceptible  to  congestion  and  inflammation  from 
exposures  than  at  any  other  time,  and  from  the  manner  in 
which  women  dress,  it  is  surprising  that  there  is  not  more 
sickness  among  them  than  there  really  is.  Wide  and  open 
cotton  drawers,  and  skirts  hanging  loosely  around  their  limbs, 
with  cotton  hose,  are  no  protection  against  drafts  and  sudden 
changes,  so  that  it  often  happens  that  the  extremities  are 
chilled  and  cold,  which  is  in  itself  sufficient  to  cause  uterine 
diseases.  When  this  exposure  continues,  with  some  already 
existing  disease,  it  will  neutralize  the  best-directed  efforts  to 
accomplish  a  cure. 


HYGIENIC   MEASURES.  191 

It  is  said  of  the  celebrated  Boerhave,  that  among  his 
effects  there  was  a  carefully-sealed  prescription,  which  con- 
tained the  secret  for  preserving  health  and  vigor  to  a  ripe  old 
age.  In  his  last  will  and  testament  it  was  provided  that  the 
prescription  should  be  sold  to  the  highest  bidder  at  public 
auction.  A  physician  who  was  anxious  to  procure  the  recipe 
of  this  renowned  Dutch  doctor,  bought  it  for  a  very  high  price. 
On  breaking  the  seal  and  anxiously  unfolding  the  paper, 
he  found  these  words:  "Keep  the  head  cool,  the  extremities 
warm,  and  the  abdomen  free."  The  buyer  was  greatly  cha- 
grined at  the  simplicity  of  the  supposed  panacea,  but,  if  the 
profession  and  the  public  only  appreciated  the  real  worth  of 
the  advice,  there  would  be  much  less  sickness. 

This  strikes  at  most  of  the  evils  in  dress  that  pave  the 
way  for  diseases  of  women.  It  comprises  the  evil  effects  of 
tight  lacing  and  compressing  the  abdominal  organs  by 
improper  support  for  the  skirts.  A  corset  should  never  be 
worn  so  tight  that  the  hand  cannot  be  passed  through  the 
waist  line.  In  the  absence  of  a  waist  or  shoulder  straps  for 
the  support  of  the  skirts  from  the  shoulders,  shoulder  straps 
should  be  fastened  directly  to  the  corset,  so  as  to  relieve  the 
hips  and  abdomen  from  the  weight  of  the  clothing. 

The  corset  waist  is  not  only  a  perfect  substitute  for  a 
corset,  in  supporting  the  bosom  and  preserving  the  form  so 
as  to  give  a  handsome  figure,  but  it  supports  the  skirts  with- 
out restricting  the  circulation  and  respiration,  or  compressing 
the  abdominal  organs.  In  buying  or  making  a  waist  or 
bodice,  particular  attention  must  be  paid  to  the  shoulder- 
bands,  so  that  these  bands  are  short  enough  to  give  the  waist 
or  bodice  support  from  the  shoulders.  If,  then,  the  skirts 
are  buttoned  to  the  waist,  the  weight  is  taken  from  the  hips, 
where  it  injuriously  depresses  the  abdominal  organs,  and 
falls  on  the  shoulders,  where  it  cannot  do  any  harm.  There 
is  a  good  deal  of  humbuggery  about  these  new  devices,  and 
those  who  make  it  a  business  to  sell  them,  never  take  the 
pains,  or  are  incompetent,  to  properly  fit  the  waist.     If  one 


192  HOME   TREATMENT. 

only  bears  in  mind  that,  if  the  waist  does  not  support  the 
skirts  from  the  shoulders,  there  is  nothing  gained  over  wear- 
ing an  old-style  corset,  imposition  is  impossible. 

The  dressing  for  the  feet  should  be  warm  and  comforta- 
ble. Women  who  go  to  balls  and  parties  should  always 
wear  overshoes  in  going  to  and  coming  from  an  enter- 
tainment. Thin  and  light  shoes  must  be  avoided  in  cold 
and  damp  weather;  in  fact,  there  is  nothing  that  women 
should  be  more  careful  about  than  too  light  and  low  shoes 
which  do  not  keep  the  feet  warm.  For  comfort  and  keep- 
ing the  feet  warm,  there  is  nothing  like  a  loosely-fitting 
leather  shoe,  with  wide  and  thick  soles,  and  a  low,  flat,  En- 
glish heel.     It  is  also  the  best  "corn  remedy"  I  know  of. 

When  the  weather  is  wet  and  cold,  rubber  overshoes 
should  be  worn,  and  these  should  be  removed  when  enter- 
ing the  house.  Women  who  have  a  tendency  to  cold 
feet,  will  find  the  cork  or  felt  soles  worn  inside  of  the  shoes, 
a  great  source  of  warmth  and  comfort.  The  coldest  stratum 
of  air  is  invariably  on  the  floor  of  the  room,  and  there  is, 
perhaps,  no  easier  or  more  unsuspected  way  to  take  a  cold 
than  to  exchange  a  pair  of  high,  warm  shoes  that  fit  closely 
around  the  ankles,  for  a  pair  of  light,  low  slippers.  If  you 
desire  to  rest  your  feet  in  a  pair  of  light  slippers,  then  add 
a  pair  of  heavy  woolen  socks  over  the  stockings,  this  will 
greatly  lessen  the  chances  of  taking  cold. 

Women  who  are  suffering  from  pelvic  or  womb  diseases, 
and  who  are  anxious  to  get  well,  and  those  who  are  troubled 
with  painful  menstruation,  and  menstrual  irregularities, 
should  wear  woolen  hose.  Thin  cotton,  silk-mixed,  or  silk 
hose  are  not  sufficiently  warm,  nor  do  they  retain  the  nat- 
ural heat  of  the  body  like  woolen  stockings. 

Those  who  have  once  accustomed  themselves  to  woolen 
hose,  should  not  discard  them  in  the  summer  months  for 
cotton,  linen  or  silk  goods,  and  this  is  to  be  particularly  ob- 
served on  this  coast,  but  the  hose  should  be  exchanged  for 
thinner  and  lighter  goods  of  the  same  material,  correspond- 
ing to  the  demands  of  the  season.     It  would  not  be  wise  or 


HYGIENIC   MEASURES.  193 

prudent  to  wear  the  same  quality  and  amount  of  clothing  in 
warm  weather  as  in  cold ;  otherwise  the  excessive  clothing 
in  the  summer  months  will  induce  perspiration  on  the 
slightest  exertion,  and  thus  the  system  becomes  most  sus- 
ceptible to  cold  when  the  weather  changes  or  becomes  cooler. 

Elastic  garters  to  maintain  the  tops  of  the  stockings  in 
position  should  be  avoided.  Rubber  bands  make  a  contin- 
uous compression  on  the  vessels  and  nerves,  although  al- 
most every  woman  claims  that  she  does  not  wear  her  gar- 
ters tight,  yet  at  night  when  she  removes  the  elastics  there 
are  deep  furrows  marking  the  constriction  of  the  garters. 
The  spring-wire  garters  are  just  as  injurious,  for  they  also 
exert  a  continuous  pressure. 

The  veins  of  the  legs  are,  for  the  most  part,  superficial, 
and  this  steady  and  gradual  compression  is  very  injurious 
to  the  venous  circulation,  so  that  the  blood  is  prevented 
from  returning  from  the  limbs  as  readily  as  it  should ;  this 
induces  cold  feet,  and  when  the  circulation  is  already  weak, 
it  often  imparts  a  feeling  of  heaviness  to  the  limbs,  for 
which  women  doctor  but  without  getting  any  relief.  The 
only  proper  support  for  the  hose  is  elastic  straps  that  are 
supported  from  the  waist;  they  are  now  so  well  known  and 
for  sale  in  every  dry  goods  store  that  a  description  of  them  is 
unnecessary. 

To  keep  the  legs  and  body  warm  is  not  a  question  of 
quality  or  quantity  of  skirts  or  wraps.  If  the  limbs  under 
them  are  not  separately  enveloped  and  are  only  covered  with 
thin  cotton  or  silk  hose  and  open  cotton  drawers,  women  are 
continuously  exposed  to  the  cold,  damp  emanations  from  the 
ground  and  to  the  drafts  caused  by  the  motion  of  the  skirts, 
and  blasts  of  wind. 

The  most  intelligent  suggestions  for  Dress  Reform  are 
those  that  are  directed  towards  reducing  the  weight  or  dis- 
placing the  heavy,  stiff,  and  unwieldy  skirts  and  clothing 
the  extremities  of  the  female  in  divided  garments,  so  that 
they  are  no  longer  exposed  to  the  dangers  of  cold  and  drafts. 
The  divided  skirt  is  in  the  direct  line  of  a  modest  and  desir- 
13 


194  HOME   TREATMENT. 

able  improvement  of  woman's  dress,  and  it  is  growing  in 
popularity  among  the  most  intelligent  of  reading  and  think- 
ing women.  If  the  specialists  of  female  diseases  were  to  study 
the  interests  of  their  patients  with  the  same  ardor  that  they 
study  the  methods  how  best  to  fill  their  offices  with  patients, 
on  whom  they  perform  useless  and  dangerous  operations, 
they  would  be  of  some  actual  benefit  to  our  wives,  mothers, 
and  sisters,  and  our  women  could  be  dressed  as  gracefully 
as  at  present  with  less  than  half  the  underclothes  to  pack 
around  with  them. 

I  am  decidedly  opposed  to  anything  approaching  in  style 
or  shape  the  bloomer  costume;  the  present  style  of  outside 
dress  cannot  possibly  be  improved  for  a  comely  garment, 
but  it  is  underneath  this  that  an  entire  change  should  be 
speedily  effected.  The  divided  skirt  is  cut  like  drawers  that 
have  a  width  of  thirty  to  forty  inches  of  goods  in  each  leg. 
I  believe  that  the  width  of  each  leg  should  not  be  more 
than  twenty-five  to  thirty  inches;  this  makes  the  skirt 
warmer  and  lighter.  Tins  is  not  attached  to  a  band  to- 
fasten  around  the  waist,  but  to  a  yoke,  which  should  be  but- 
toned to  the  bodice  waist,  suspending  the  skirt  from  the 
shoulders.  The  material  will  be  a  matter  of  individual 
taste;  the  two  qualities  that  should  be  always  looked  for  are 
softness  and  warmth,  and  for  that  reason  Jersey  flannel  and 
ladies'  cloth  are  the  most  suitable  material ;  in  summer  or 
warm  climates,  pongee  or  wash  silks  may  be  substituted. 

The  skirt  is  cut  on  the  bias  to  fit  the  hips,  where  it  is 
fulled  in  and  attached  to  a  yoke  instead  of  a  band  and  in 
the  back  it  laps  about  two  or  three  inches.  The  advantage 
of  the  divided  skirt  is  that  it  protects  the  limbs  and  body 
against  drafts  and  cold  emanations,  and  takes  the  place  of 
all  undershirts  and  petticoats.  This  skirt  alone,  however, 
would  be  insufficient  to  accomplish  all  that  is  desired  by 
way  of  guarding  against  exposures;  for  this  reason  there  is 
also  a  so-called  Union  suit  worn  under  the  divided  skirt  to 
complete  the  covering  of  the  limbs. 

Union  suits,  as  the  name  implies,  unite  a  pair  of  closely- 


HYGIENIC   MEASURES.  195 

fitting  drawers  with  an  undershirt.  There  is  no  particular 
advantage  in  uniting  the  underdrawers  with  the  undershirt, 
but  there  is  certainly  no  disadvantage.  The  principal  ob- 
ject that  is  to  be  attained  is  not  in  unionizing  drawers  and 
shirts,  but  wearing  such  closely-fitting  undergarments  that  the 
extremities  are  permanently  protected,  and  in  having  them 
so  lapped  or  closed  that  the  abdomen  and  pelvic  organs  are 
securely  protected  against  cold. 

Equestrian  tights  are  made  on  the  same  principle  and 
for  a  similar  purpose  as  union  suits,  namely,  to  properly 
and  surely  cover  the  limbs  and  in  a  measure  displace  the 
great  load  of  petticoats  that  women  usually  wear.  They 
•come  in  drawers  and  also  in  combination  suits  with  the  un- 
dershirts; a  choice  may  be  left  to  individual  taste.  There 
are  different  brands  of  these  goods  on  sale  in  all  the  dry 
goods  stores  of  our  large  cities,  the  prices  being  regulated  by 
material  and  quality  of  the  goods  from  which  they  are 
made.  The  woolen  goods  are  preferable  for  practical 
purposes. 

Women  who  do  not  like  the  woven  closely-fitting  drawers 
<jan  take  their  choice  between  the  latter  and  home-made 
flannel  drawers,  the  French  flannel  for  the  lighter  and  the 
English  bully  for  heavier  and  warmer  clothing  will  be 
found  to  be  the  most  serviceable  materials;  patterns  for 
making  up  closed  or  button  drawers  may  be  had  at  the 
leading  pattern  stores  of  any  city. 

Women  who  cannot  grow  up  to  an  appreciation  of  the 
divided  skirt  should  by  all  means  wear  equestrian  tights  or 
buttoned  flannel  drawers,  under  cotton  or  linen  ones;  this 
will  enable  them  to  throw  off  one  or  two  petticoats  or  skirts 
because  the  drawers  will  safely  substitute  the  skirts  and  be 
much  lighter.  Some  women  dread  the  absence  of  skirts  on 
account  of  appearing  too  scant;  a  little  extra  fullness  and 
drapery  to  the  dress  make  the  absence  of  skirts  not  notice- 
able. If  this  were  not  quite  so,  there  appears  no  satisfac- 
tory reason  why  a  woman  should  feel  embarrassed  to  mod- 
estly display  the  contour  of  her  form  any  less  than  a  man. 


CHAPTER  XV. 

METRITIS  OR  INFLAMMATION  OF  THE  WOMB. 

This  is  an  inflammation  of  the  entire  substance  of  the 
womb,  which,  like  all  inflammatory  processes,  is  acute  or 
chronic. 

Inflammation  does  not  always  affect  the  whole  body  of 
the  womb,  but  it  is  quite  oftener  limited  to  one  or  the  other 
layer  or  membrane  that  enters  into  its  architectural  whole. 
Then,  again,  there  is  the  anatomical  division  of  the  organ 
into  a  body  or  corpus,  and  a  neck  or  cervix;  of  these  either 
one  may  be  affected,  without  the  other,  so  that  inflammation 
of  the  cervix  should  be  the  subject  of  a  separate  inquiry. 

Most  of  the  diseases  of  the  womb  are  due  to  inflamma- 
tion. This  was  the  opinion  of  J.  H.  Bennett,  of  London,  as 
long  ago  as  1845,  in  which  year  the  first  edition  of  his  work 
on  "Inflammation  of  the  Uterus"  was  published.  Up  to 
that  time,  the  subject  had  never  been  practically  pursued  to 
the  same  logical  conclusions,  so  that  the  opinions  of  the 
leading  professional  minds  were  far  from  unanimous  on 
this  question.  But  the  vigor  and  energy  with  which  the 
young  author  defended  his  views,  forced  attention  and  con- 
viction upon  the  greater  part  of  the  profession,  in  this  coun- 
try and  Europe. 

He  started  out  with  a  view  to  prove:  "1.  That  inflam- 
mation is  the  primum  mobile  in  uterine  affections,  and  that 
from  it  follow,  as  results,  displacements,  ulcerations  and  af- 
fections of  the  appendages.  2.  That  menstrual  troubles  and 
leucorrhcea  are  merely  symptoms  of  this  morbid  state.  3. 
That  in  the  vast  majority  of  cases,  inflammatory  action  will 
be  found  to  confine  itself  to  the  cervical  canal  and  not  to 
affect  the  cavity  of  the  body." 

(190) 


INFLAMMATION   OF   THE   WOMB.  197 

Since  the  appearance  of  the  first  edition  of  Dr.  Bennett's 
work,  which  is  now  forty-six  years  ago,  there  have  been 
many  careful  and  clever  observers  in  this  field  of  pathology, 
but  there  is  yet  to  appear  a  successful  contradiction  of  the 
truth  of  his  inflammatory  doctrine.  Twenty -six  years  after 
Dr.  Bennett  wrote  the  above  book,  he  read  a  paper  before 
the  British  Medical  Association  on  the  same  subject,  in 
which  there  is  no  modification  of  his  first  conclusions  on 
the  importance  of  inflammatory  lesions.  He  says:  "  1.  Uter- 
ine displacements  are  by  many  too  much  studied  per  se  (by 
themselves)  independently  of  the  inflammatory  diseases  that 
complicate  and  often  occasion  them.  2.  That  the  exami- 
nations made  to  ascertain  the  existence  of  inflammatory  com- 
plications are  often  not  made  with  sufficient  care  and  mi- 
nuteness, as  evidenced  by  the  fact  that  I  constantly  see  in 
practice  cases  in  which  inflammatory  processes  have  been 
entirely  neglected,  and  the  secondary  displacements  alone 
treated.  3.  That  inflammatory  lesions  are  often  the  princi- 
pal cause  of  the  uterine  displacements  through  the  enlarge- 
ment and  increased  weight  of  the  womb,  or  a  portion  of  its 
tissues,  which  they  occasion.  4.  That  when  such  inflam- 
matory conditions  exist,  as  a  rule  they  should  be  treated 
and  cured  and  then  time  given  to  nature  to  absorb  morbid 
enlargements  before  mechanical  and  surgical  measures  are 
resorted  to." 

If  these  propositions  could  be  engrossed  and  a  copy  sent 
to  every  doctor  in  the  land,  as  a  safe  and  sure  guide  in  his 
treatment  of  diseases  of  women,  it  would  prove  a  great  boon 
to  the  suffering  women  of  this  country.  One  of  the  notori- 
ous abuses  of  the  profession,  is  the  penchant  for  the  employ- 
ment of  mechanical  means,  either  by  means  of  instruments 
or  the  surgeon's  knife.  Women  are  wantonly  subjected  to 
painful  and  tedious  treatments  which  in  many  cases  only 
aggravate  their  original  suffering,  while  a  few  simple  rules 
of  hygienic  treatment  would  not  only  restore  them  to  health 
and  vigor,  but  would  save  them  the  privation  of  paying  fees 


198  HOME   TREATMENT. 

to  incompetent,  unscrupulous  or  avaricious  doctors,  who 
have  only  one  ambition,  that  is,  to  get  the  patient's  money. 
I  have  known  an  instance  where  this  barbarous  course  under 
the  guise  of  scientific  treatment,  broke  up  the  home  of  a  once 
happy  and  prosperous  couple,  and  finally  when  the  resources 
were  so  low  that  the  expense  incident  to  housekeeping  and  a 
nurse  could  no  longer  be  defrayed,  the  household  effects 
were  disposed  of,  and,  as  a  last  resort,  the  overdoctored 
woman  was  taken  to  a  hospital,  where  her  last  hopes  were 
lulled  into  an  artificial  sleep,  while  the  surgeons  performed 
an  operation  from  which  her  depleted  body  and  squandered 
vitality  could  never  recover.     She  died. 

I  am  convinced  from  observations  in  large  female  clinics 
in  Berlin,  and  from  my  own  studies  in  the  pathological 
laboratory  while  a  student  abroad,  that  Dr.  Bennett's  con- 
clusions are  corroborated  by  actual  facts.  The  freedom  with 
which  dangerous  operations  are  undertaken  for  compara- 
tively trivial  complaints  is  degenerating  into  a  license  that 
is  criminal  and  which  in  some  cases  is  nothing  less  than 
murder.  In  the  absence  of  a  high  moral  sentiment  which 
should  control  the  profession,  but  does  not,  the  State  must  step 
in  and  say  who  shall  practice  medicine  and  surgery,  and  by 
limiting  competition,  the  evil  propensity  to  make  the  most 
of  one's  opportunities  will  not  be  elevated  into  a  fine  art,  and 
men,  although  unscrupulous,  may  be  at  least  indifferent 
honest. 

Acute  metritis  comes  on  suddenly,  and  this  occurs  quite 
often  during  the  menstrual  period.  Women  as  a  rule  are 
altogether  too  careless  during  menstruation ;  they  seem  to 
forget  that  at  this  time  the  womb  is  congested  and  swollen, 
and  that  if  the  natural  flow  of  the  blood  is  interfered  with, 
this  congestion  will  turn  into  an  inflammation.  Exposure 
to  cold,  or  getting  the  feet  damp,  or  inordinate  exercise 
that  overheats  the  system,  will  bring  this  about.  Some- 
times there  may  be  a  tumor  or  swelling  in  the  womb  which 
occludes  the  cervical  canal,  so  that  the  menstrual  fluid  can- 


INFLAMMATION   OF   THE   WOMB.  199 

not  escape;  this  will  also  cause  inflammation.  A  stricture 
of  the  cervical  canal,  occasioned  by  the  womb  being  flexed, 
will  interfere  with  the  egress  of  the  menstrual  flow,  and  this 
also  may  give  rise  to  inflammation.  Vaginal  injections 
either  too  hot  or  too  cold,  and  particularly  immediately 
after  copulation,  when  the  pelvic  organs  are  still  in  a  high 
state  of  congestion,  is  quite  liable  to  excite  metritis.  Gonor- 
rhceal  infection  is  another  source  of  inflammation,  but  this 
is  invariably  preceded  by  an  endometritis,  which  I  will  con- 
sider separately. 

Large,  ill-fitting  pessaries  worn  in  the  vagina  for  a  sup- 
posed retroflected  or  prolapsed  uterus,  or  a  stem  pessary,  are 
fruitful  causes  of  metritis. 

Other  causes  are  criminal  abortion,  complicated  with 
blood  poisoning  from  the  unclean  probes  or  instruments,  that 
the  abortionist  has  employed  on  previous  operations  with- 
out thoroughly  cleansing  and  disinfecting  them ;  the  appli- 
cation of  strong  caustics  to  the  cervix  of  the  womb,  as  well 
as  injections  into  the  cavity  of  the  uterus.  Meddlesome  doc- 
toring by  means  of  the  unskillful  and  unnecessary  use  of  in- 
struments, like  the  probing  of  the  womb  without  proper  an- 
tiseptic precautions,  or  the  scraping,  stretching  or  operating 
on  the  womb  without  the  essential  antiseptic  precautions 
which  a  scientific  comprehension  of  the  subject  demands, 
has  frequently  caused  this  affection. 

It  occurs  very  often  as  a  part  of  the  general  inflamma- 
tion produced  by  the  absorption  of  putrid  or  septic  matter 
during  the  childbed  period.  This  indicates  a  lack  of  clean- 
liness on  the  part  of  the  attendants  during  confinement;  in- 
flammations of  this  nature  constitute  one  of  the  types  of 
puerperal  or  childbed  fever. 

The  most  prominent  symptom  is  pain.  This  is  greatly 
aggravated  on  the  slightest  pressure,  or  on  moving  or  turn- 
ing in  bed.  Upon  a  digital  examination,  the  womb  is  found 
enlarged  or  swollen,  and  when  the  organ  is  tilted  up  on  the 
examiner's  finger,  there  is  a  sharp  lancinating  pain  radia-. 
ting  from  it  in  all  directions. 


200  •*    _    HOME    TREATMENT. 

The  first  symptoms  of  pain  are  always  accompanied  with 
fever,  and  this  may  have  been  ushered  in  or  alternated  with 
a  chill.  The  pain  may  be  first  felt  rather  deeply  in  the  pel- 
vis, and  this  is  increased  by  a  frequent  desire  to  pass  urine 
and  a  straining  of  the  rectum.  It  may  further  become  com- 
plicated with  a  looseness  of  the  bowels,  or  an  obstinate  con- 
stipation. Nausea  and  vomiting  is  a  frequent  symptom  dur- 
ing the  course  of  the  disease,  and  if  the  metritis  is  developed 
during  menstruation,  the  flow  may  suddenly  stop,  but,  on 
the  other  hand,  the  hemorrhage  may  become  alarmingly 
profuse.  Standing,  walking,  coughing  and  straining  at 
stool  excite  the  most  excruciating  pain,  so  that  a  recumbent 
quiet  position  is  the  only  comfortable  way  for  the  patient  to 
maintain  herself,  with  the  head  as  low  as  possible  to  insure 
the  most  easy  recumbency. 

The  treatment  for  acute  metritis  depends  somewhat  on 
the  cause  in  each  individual  case.  There  are,  however,  two 
indications  that  require  to  be  met,  and  these  are  common  to 
all  inflammations,  namely,  to  relieve  the  pain  and  check  the 
inflammatory  process. 

The  former  is  quickly  relieved  by  introducing  into  the 
vagina  a  Femina  vaginal  capsule  in  the  usual  manner; 
repeating  every  six  to  eight  hours,  until  the  pain  is  suffi- 
ciently alleviated  to  occasion  no  suffering;  then  one  capsule 
should  be  employed  every  night  until  cured  or  until  restless- 
ness requires  that  something  must  be  done  to  calm  the 
patient. 

If  the  metritis  is  due  to  suppressed  or  checked  menstrua- 
tion from  cold  or  exposure,  then,  and  only  then,  are  hot 
fomentations  over  the  entire  abdomen  the  most  appropriate 
application,  and  if  the  patient  is  plethoric,  I  advise  a  half- 
dozen  leeches  to  the  inguinal  region  of  one  or  both  sides  to 
be  of  unequaled  value  for  checking  the  disease. 

Until  my  experience  and  observation  in  German  hos- 
pitals, I  was  in  the  habit  of  employing  hot  applications  for 
all  acute  inflammations  of  the  abdominal  organs.  These 
were  either  in  the  form  of  hot-water  fomentations  or  flax- 


INFLAMMATION  OF  THE    WOMB.  201 

seed  poultices.  Hot  applications  undoubtedly  give  relief, 
but  I  doubt  whether  they  ever  cut  short  or  abridge  the  in- 
flammatory process  in  any  case.  I  am  inclined  to  believe 
that  in  a  great  many  instances  hot  fomentations  have  the 
tendency  to  encourage  suppuration,  and  that  an  abscess  is 
often  the  result  of  their  use.  I  have  seen  decidedly  better 
results  from  cold  applications,  and  the  colder  the  better,  so 
that  I  now  employ  them  universally  in  all  acute  inflamma- 
tions of  the  pelvic  organs  except  in  the  noted  exception  in 
which  the  inflammation  is  due  to  a  sudden  check  of  the 
menses  from  exposure.  As  a  preventive  of  inflammations, 
after  delicate  operations  on  the  uterus,  I  apply  the  rubber  ice 
bag  with  invariable  success. 

The  most  suitable  rubber  bag  for  this  purpose  is  a  size 
of  six  by  twelve  inches ;  it  should  be  filled  with  broken  pieces, 
and  then  securely  tied.  I  prefer  to  envelop  the  bag  in  a 
thin  layer  of  flannel,  so  as  to  take  off  the  cold,  clammy  sen- 
sation which  the  rubber  imparts  to  the  skin.  There  should 
be  two  of  these  bags,  in  case  of  accidentally  tearing  one,  and 
so  that  the  reserved  one  may  be  in  readiness  when  the  other 
is  removed.  The  cold  does  not  only  check  and  control  the 
inflammation, but  it  also  benumbs  the  nerves,  so  that  it  greatly 
relieves  pain.  I  keep  these  ice  bags  applied  over  the  region 
of  the  womb,  until  all  the  acute  symptoms  disappear.  The 
vagina,  however,  should  be  irrigated  with  medium  hot  borax 
water,  once  a  day,  so  as  to  remove  any  irritating  discharge 
from  the  uterine  cavity. 

The  digestive  derangements  that  so  often  accompany 
acute  metritis;  the  nausea  and  vomiting  of  this  and  kin- 
dred diseases,  are  alleviated  by  this  formula : — 

NO.   IX. 

Take:  Subcarbonate  of  bismuth 2  drams 

Bicarbonate  of  sodium 2  drams 

Tr.  of  opium,  deodorized 2  drams 

Tr.  of  nux  vomica 1  dram 

Simple  syrup 1  ounce 

Peppermint  water,  sufficient  to  make 6  ounces 


202  HOME   TREATMENT. 

Mix,  and  take  a  tablespoonful  every  one  or  two  hours, 
until  relieved;  to  allay  the  thirst  and  dryness,  take  small 
pieces  of  ice.  Constipation  of  the  bowels  should  be  relieved 
by  taking  a  Femina  laxative  tablet  every  six  hours  until  the 
stools  are  freely  moved ;  after  that  one  should  be  taken  every 
night  or  perhaps  every  other  night,  so  as  to  keep  the  system 
regulated. 

Some  persons  suffer  from  costiveness  because  they  do  not 
drink  enough  water,  and  when  taking  medicines  to  correct 
this  disorder  it  is  always  well  to  drink  a  large  tumblerful  of 
water  at  the  same  time,  and  especially  at  bedtime,  three  or 
more  hours  after  supper,  and  early  in  the  morning  is  another 
good  time  for  drinking  water  and  taking  a  laxative. 


CHAPTER    XVI. 

CHRONIC  METRITIS  OR  CHRONIC  INFLAMMATION 
OF  THE  WOMB. 

When  from  neglected  or  improper  treatment,  the  acute 
inflammation  is  not  checked,  so  as  to  restore  the  organ  to  its 
normal  condition,  the  inflammatory  process  assumes  a 
chronic  character.  As  inflammation  is  an  abnormal  vital 
activity,  which  results  in  the  proliferation  or  building  up  of 
fibrous  tissue,  it  must  be  naturally  inferred  that  if  the  in- 
flammatory process  is  active  in  an  organ  for  a  considerable 
length  of  time,  the  tissues  of  this  organ  must  grow  or  in- 
crease, so  as  to  augment  its  size  and  weight.  This  is  in- 
deed so,  hence  the  other  names  that  have  been  given  to  this 
disease  to  distinguish  it  from  the  acute  or  transient  form,  all 
imply  tissue  growth,  as  hypergenesis  of  the  connective  tissue, 
engorgement  or  inflammatory  hypertrophy  of  the  uterus. 

The  entire  organ  may  be  thus  affected,  or  it  may  be  lim- 
ited to  either  one  or  the  other  anatomical  divisions  of  the 
uterus,  namely,  the  body  or  the  neck. 

Of  all  the  different  varieties  of  chronic  inflammation 
of  the  womb,  that  of  the  neck  or  cervix  is  the  most  fre- 
quently met.  This  is  due  to  the  fact  that  in  married  women 
and  those  who  have  born  children  the  cervix  of  the  womb 
is  exposed  to  mechanical  injury  from  coition,  friction  against 
the  vaginal  walls  in  walking  and  from  lacerations  during 
delivery. 

The  body  of  the  womb  is  further  removed  from  all  these 
mechanical  agencies  to  which  the  cervix  is  exposed,  for  the 
body  is  within  the  abdomen  of  the  female,  and  for  that  rea- 
son it  is  less  liable  to  be  injuriously  affected  by  influences 
that  cause  inflammatory  enlargement.  But  notwithstand- 
ing all  this,  it  is  a  common  disease. 

6  (203) 


204  HOME   TREATMENT. 

A  great  many  cases  of  womb  complaint  that  do  not 
yield  to  ordinary  treatment  are  really  of  this  nature,  but 
owing  to  carelessness  or  incompetency  are  never  recognized. 
The  symptoms  of  this  disease,  which  are  obstinate  leucorrhcea, 
falling  of  the  womb  or  displacements,  are  mistaken  and 
treated  for  the  disease  itself.  Women  who  suffer  with  this 
complaint  are  extremely  liable  to  go  on  for  quite  a  while 
feeling  comparatively  well  and  in  hopes  that  they  are  recov- 
ering, when  some  extra  exertion  or  exposure  to  cold  brings 
on  a  relapse,  which  lights  up  an  acute  inflammatory  process. 
This  passes  into  the  old  troublesome  disease  and  this  re- 
sumes its  chronic  form.  After  a  repetition  of  the  general 
routine  treatment,  the  patient  may  again  live  under  the  de- 
lusion that  she  is  going  to  get  well  only  to  have  her  hopes 
blasted  by  a  sudden  reappearance  of  the  former  painful 
symptoms,  that  are  alike  discouraging  to  herself  and  a 
puzzle  to  her  friends. 

The  cause  of  inflammatory  enlargement  of  the  uterus  is 
usually  connected  with  parturition  or  abortion. 

There  never  can  be  either  the  one  or  the  other  without 
more  or  less  vascular  activity,  which  is  essential  to  the  repair 
of  the  womb  and  its  restoration  to  its  physiological  or 
healthy  condition.  All  the  uterine  tissues  are  at  this  time 
in  a  high  state  of  irritability,  and  if  there  is  a  natural  pre- 
disposition to  inflammatory  diseases,  then  the  slightest  ob- 
stacle to  an  uninterrupted  recovery  will  kindle  an  inflam- 
matory action,  that  will  fasten  itself  on  the  uterus.  In  the 
very  nature  of  things  this  results  in  a  deposition  of  inflam- 
matory material,  with  a  consequent  increase  of  intermuscu- 
lar fibrous  tissue  which  increases  the  size  and  weight  of  the 
uterus. 

What  our  mothers  termed  in  former  days  "a  bad  get- 
ting up,"  that  is,  when  women  get  up  from  their  confine- 
ment weakly  and  with  more  or  less  pain  and  dragging  in 
the  pelvis  on  walking  or  the  slightest  exertion,  is  generally 
owing  to   the  above-described  condition.     This   disease   is 


CHRONIC   METRITIS.  205" 

now  almost  as  common  as  ever.     I  can  always  trace  these 
cases  to  a  confinement  or  an  abortion. 

It  is  very  rare  that  it  is  due  to  a  depreciation  of  vital 
forces  from  improper  food,  over-exertion,  a  prolonged  nerv- 
ous depression  or  a  constitutional  tendency  to  tubercle, 
scrofula  or  some  other  hereditary  diathesis,  although  these 
undoubtedly  predispose  the  patient  to  the  disease. 

Abortions  stand  at  the  head  of  all  the  causes  that  excite 
this  affection.  When  the  uterus  is  pregnant  and  its  natural 
growth  is  abruptly  checked  by  the  destruction  of  the  em- 
bryo, then  the  organ  becomes  at  once  the  seat  of  a  conges- 
tion and  great  vascular  activity,  for  the  purpose  of  repairing 
the  injury  that  the  premature  expulsion  of  the  embryo  or 
fetus  inflicted. 

If  this  congestion  is  delayed  from  improper  care  or  treat- 
ment which  fails  to  recognize  the  important  fact  that  an 
abortion  or  interruption  of  pregnancy  is  a  much  greater 
shock  to  the  system  than  a  delivery  at  full  term,  it  must 
result  in  arrested  involution  or  permanent  inflammatory 
enlargement.  This  most  persons  fail  to  appreciate,  and,  as 
a  result,  they  do  not  take  the  same  precautions  that  they 
would  after  the  delivery  of  a  living  or  fully-developed  child. 

I  am  well  aware  that  criminal  abortionists  are  in  the 
habit  of  deceiving  their  patrons  by  assuring  them  that  there 
is  no  danger  or  bad  results  to  be  feared  from  their  criminal 
operations.  This  is  a  vicious  falsehood,  and,  coupled  with  the 
statement  that  there  is  as  yet  no  living  being  in  the  womb, 
the  crime  of  manslaughter  is  added  to  that  of  malpractice. 
In  every  case  of  abortion,  whether  accidental  or  criminal, 
the  same  care  and  attention  must  be  given  to  the  woman 
as  during  any  natural  lying-in  period. 

There  is  a  class  of  chronic  inflammations  that  I  have 
noticed  in  women  who  have  always  suffered  from  painful 
menstruations  or  from  excessive  or  prolonged  hemorrhage 
at  the  regular  monthly  period.  This  is  complicated  with 
some  ovarian  disease,  which  yields,  however,  to  appropriate 
treatment. 


206  HOME    TREATMENT. 

There  is  quite  a  series  of  symptoms  that  denote  the  ex- 
istence of  chronic  metritis;  these  are  not  all  present  in  each 
particular  case  but  quite  enough  of  them  to  diagnose  the 
disease.  Some  of  these  symptoms  are  in  the  nature  of  com- 
plications, which  in  themselves  may  be  mistaken  for  an  indi- 
vidual disease,  but  upon  a  careful  inquiry  they  can  be 
traced  directly  to  a  chronic  metritis,  which  if  removed  dis- 
poses of  all  the  lesser  ailments. 

The  following  are  the  most  noted  signs  of  this  affection : 
painful  copulation,  and  pain  on  defacation ;  a  dull,  heavy, 
dragging  pain  through  the  pelvis,  much  increased  by  walk- 
ing; during  menstruation  the  mammse  are  sensitive  or 
painful ;  several  days  before  the  approach  of  the  menses 
there  is  a  dull  pain,  which  lasts  during  the  menstrual  flow ; 
around  the  nipples,  there  is  pigmentration  or  darkening ; 
sometimes  nausea  and  vomiting,  and  dyspepsia,  headache, 
and  languor ;  pressure  on  the  rectum  with  tenesmus  and 
hemorrhoids ;  leucorrhcea  from  catarrh  of  the  womb;  pressure 
on  the  bladder  with  tenesmus  or  straining. 

This  disease  may  continue  for  years  uninterruptedly, 
and,  if  there  is  not  a  cure  accomplished,  or  successful  meas- 
ures for  its  relief  are  not  employed,  it  will  continue  until  the 
menopause,  or  change  of  life,  which  may  effect  a  sponta- 
neous cure. 

The  enlargement  is  most  noticeable  in  the  cervix  or  neck. 
This  is  sometimes  so  great  as  to  extend  one  or  two  inches 
into  the  vagina,  and  this  condition  is  often  mistaken  for 
falling  of  the  womb  or  prolapse,  which  is  far  from  a  correct 
diagnosis.  A  growing  of  the  womb  from  chronic  inflam- 
mation is  the  proper  explanation. 

The  hygienic  suggestions  given  in  a  former  chapter, 
form  an  important  auxiliary  in  the  treatment  of  this  com- 
plaint, and  for  that  reason  it  should  be  carefully  studied. 

The  treatment  of  chronic  metritis  has  been,  up  to  within 
a  very  recent  period,  anything  but  satisfactory  in  its  results. 
This  was.  owing  to  an  inadequate  knowledge  of  the  real 
nature  of  the  disease,  which  was  marked  by  so  many  symp- 


CHRONIC   METRITIS.  207 

toms  that  were  in  themselves  obscure  and  hard  to  separate 
as  such,  from  the  main  affection. 

This  confusion  of  the  true  nature  of  the  pathological  proc- 
ess, resulted  in  a  great  many  vague  therapeutical  resources, 
so  that  the  treatment  is  even  yet  far  from  uniform  and  thor- 
ough. Many  of  the  recognized  resources  laid  down  in  the 
text-books,  on  diseases  of  women,  are  not  only  useless,  but 
absolutely  injurious,  and,  in  order  to  save  the  reader  time 
and  money,  I  will  make  a  brief  mention  of  the  most  promi- 
nent of  them. 

Depletion,  or  the  abstraction  of  blood  in  chronic  metritis, 
effects  no  permanent  benefit  in  the  inflammatory  process.  I 
am  convinced  that,  in  the  long  run,  the  patients  grow  worse, 
because  this  treatment  lowers  the  vitality  and  reduces  the 
recuperative  forces,  which  are  so  important,  in  the  treatment 
of  all  chronic  complaints. 

Scarifications  or  puncturing  the  cervix  with  a  sharp 
lance  or  pointed  knife,  will  not  sufficiently  impress  the 
morbid  process,  so  as  to  stimulate  it  into  a  healthy  action. 

Some  authors  speak  very  highly  of  cauterizations  and 
blisters  upon  the  neck  or  lips  of  the  womb ;  this  I  have  re- 
peatedly tried,  and  in  not  a  single  instance  was  it  of  the 
slightest  use,  but  it  aggravated  the  symptoms,  and  in  one 
case  it  excited  a  severe,  acute  metritis  that  proved  almost  fatal. 

Specialists,  as  a  rule,  fall  into  routine  practice,  and  exer- 
cise neither  originality  or  intelligence  in  practice,  outside  of 
the  text-book  on  their  shelf.  They  inject  strong  fluids  or 
caustics  into  the  cavity  of  the  womb  with  a  view  of  checking 
the  inflammation  in  that  manner.  This  treatment  is  dan- 
gerous and  delusive.  If  the  patient  endures  the  treatment, 
she  may  be  stimulated  for  a  time  with  the  idea  that  some- 
thing very  curative  is  being  done,  but  my  experience  has 
been  that  the  disease  only  becomes  worse,  because  the  womb 
is  too  delicate  and  sensitive  an  organ  to  improve  under  these 
repeated  irritating  assaults. 

There  is  a  home  treatment  for  mild  cases  which  I  recom- 
mend to  my  patients,  with  satisfactory  results.     It  consists 


208  HOME   TREATMENT. 

principally  of  dissolving  one  teaspoonful  of  the  Femina 
uterine  lotion  in  a  cupful  of  boiling  hot  water,  after  which 
this  should  be  added  to  a  gallon  of  warm  water  of  a  tem- 
perature of  105  degrees  F.;  these  irrigations  are  to  be  taken 
every  night,  and  if  the  water  can  be  borne  hotter  the  tem- 
perature may  be  gradually  increased  to  107  degrees  F.  A 
napkin  should  be  worn  and  the  bed  warmed  with  a  hot  wa- 
ter bag  before  retiring.  Ten  to  fifteen  minutes  later  a 
Femina  vaginal  capsule  is  to  be  introduced  high  up  into  the 
vagina,  by  first  quickly  dipping  the  capsule  into  warm 
water. 

In  obstinate  cases  I  have  used  electricity  with  the  great- 
est success.  This  is  administered  by  means  of  a  broad  dis- 
persing electrode  applied  on  the  abdomen,  and  another 
electrode,  covered  with  a  sponge,  is  carried  up  the  vagina,  to 
the  womb.  In  this  manner  I  employ  an  intensity  of  sixty 
to  one  hundred  and  fifty  milliamperes,  for  ten  to  fifteen 
minutes.  This  is  repeated  several  times  a  week,  and  from 
three  to  six  weeks,  and  with  other  hygienic  treatment  the 
patient  recovers. 

When  women  are  in  moderate  circumstances,  and  can 
spare  neither  time  nor  money  to  visit  the  office,  for  the 
length  of  time  that  is  required  for  the  electrical  treatment,  I 
follow  the  plan  of  the  Berlin  clinic,  which  originated  in 
Vienna,  with  Prof.  Carl  Braun,  and  is  strongly  recom- 
mended and  practiced  by  Dr.  Martin,  in  Berlin.  This  con- 
sists in  an  amputation  of  the  cervix,  or,  in  other  words,  the 
abnormally  elongated  and  enlarged  uterus  is  trimmed  down, 
and  the  diseased  membrane  is  scraped  out.  While  the 
cervix  is  recovering  from  the  operation,  there  is  also  a  dim- 
inution in  the  size  of  the  body  of  the  organ,  and  the 
chronic  inflammation  subsides  with  it.  This  operation  is 
not  dangerous  to  life,  and  in  my  experience  I  have  as  yet 
never  had  a  bad  symptom  to  interrupt  the  recovery.  In  ob- 
stinate cases,  it  is,  perhaps,  one  of  the  most  useful  surgical 
measures  that  was  ever  devised,  and  we  owe  it  to  the  genius 
of  Professor  Braun,  that  all  obstinate  cases  of  this  nature  are 
amenable  to  successful  treatment. 


CHAPTER  XVII. 

ENDOMETRITIS  OR  CATARRHAL   INFLAMMATION 
OF  THE  WOMB. 

Endo  means  within,  and  metritis  signifies  womb  and  in- 
flammation, and  when  all  are  combined,  the  compound  term 
denotes  imflammation  of  the  lining  membrane  of  the  womb, 
which  is  the  affection  that  I  am  now  to  consider. 

It  would  be  impossible  to  find  a  single  person  of  middle 
age  who  has  not  experienced  sometime  during  life  the  dis- 
comforts of  a  catarrh  or  cold  of  some  part  of  the  respiratory 
passages,  whether  in  the  head  or  bronchial  tubes. 

The  mucous  membranes  are  especially  sensitive  to  nox- 
ious influences,  and  sound  a  timely  note  of  warning  by  an 
acute  catarrh,  which,  if  heeded,  will  in  many  instances  save 
the  person  from  a  dangerous,  if  not  fatal  sickness. 

The  adage,  "Prevention  is  better  than  cure,"  is  one  of 
the  most  truthful  sayings  in  the  English  language,  and,  if 
persons  would  profit  from  the  admonitions  of  a  "  slight  cold," 
many  a  fatal  pneumonia  or  bronchitis  could  be  averted. 

What  is  true  of  the  mucous  membrane  that  is  common 
to  both  sexes  is  true  of  that  which  is  peculiar  to  the  female 
organs  alone. 

There  is  no  mucous  membrane  that  is  more  liable  to 
catarrhal  inflammations  than  that  lining  the  uterus. 
There  never  was  a  woman  who  was  not  some  time  in  her 
life  afflicted  with  a  transient  uterine  catarrh.  It  may  have 
been  of  so  mild  a  form  that  the  symptoms  which  it  occa- 
sioned were  hardly  noticed,  or,  perhaps,  ascribed  to  some 
other  ailment. 

There  are  several  varieties  of  endometritis ;  some  of  these 
are  based  upon  the  length  of  time  that  the  affection  has 
14  (209) 


210  HOME   TREATMENT. 

lasted,  while  others  owe  their  classification  to  the  anatomical 
division  of  the  uterus  into  body  and  cervix.  Those  that  re- 
late to  the  duration  of  the  disease  are  either  acute  or  chronic. 

Acute  endometritis  is  the  most  common  form;  it  has  also 
been  described  under  the  names  of  acute  uterine  leucor- 
rhcea,  acute  uterine  catarrh,  and  acute  internal  metritis.  It 
usually  runs  a  rapid  course,  ending  in  recovery  or  in  the 
chronic  form.  It  undoubtedly  passes  unrecognized  in  many 
instances,  and  in  this  way  many  cases  of  painful  menstrua- 
tion or  suppressed  menstruation  are  explainable. 

It  can  be  said  that  at  each  and  every  menstrual  period 
there  is  a  physiological  catarrh,  which  belongs  to  the  natural 
process  of  the  menstrual  function.  During  each  menstrua- 
tion there  is  a  hyperemia,  or  congestion  of  the  mucous 
membrane,  so  that  the  turgent  blood  vessels  rupture,  and 
this  constitutes  the  menstrual  flow.  Before  this  congestion 
reaches  the  point  of  bursting  the  capillaries,  and  about  the 
time  that  the  sanguineous  flow  ceases,  there  is  an  increased 
and  altered  mucous  secretion  of  the  mucous  membrane.  If 
this  secretion  is  prolonged  beyond  the  normal  period  that 
constitutes  healthy  menstruation,  or  if  it  continues  to  be 
present  at  any  time  between  the  menstrual  periods,  it  con- 
stitutes a  disease  or  a  catarrh.  Now  when  we  consider  the 
close  relation  that  the  normal  functions  of  the  womb  have 
to  those  that  are  abnormal,  and  that  the  one  may  be  the 
stepping-stone  to  the  other,  we  need  not  be  surprised  that 
endometritis,  or  catarrh  of  the  womb,  is  one  of  the  most  com- 
mon affections  to  which  women  are  liable. 

Chronic  endometritis  is  where  the  disease  has  lasted  for 
a  long  time;  some  authorities  consider  it  a  rare  affection, 
but  this  is  a  great  error.  Any  disease  so  frequent  as  acute 
endometritis  must,  in  the  very  nature  of  inflammatory  proc- 
esses, become  chronic,  in  a  large  proportion  of  cases. 

Endometritis  of  the  body  of  the  womb,  in  contra-dis- 
tinction  to  a  partial  inflammation,  located  and  confined  to 
the  mucous  membrane  of  the  neck  or  cervix  of  the  womb, 


ENDOMETRITIS.  211 

forms  another  or  third  variety  of  this  affection.  This  disease 
has  been  described  under  the  names  of  chronic  corporeal 
endometritis,  uterine  catarrh,  uterine  leucorrhcea,  and  inter- 
nal metritis,  and  the  seat  of  it  is  confined  to  the  lining  mem- 
brane of  the  cavity  of  the  womb,  without  complicating  the 
•cavity  of  the  cervix;  but  there  is  no  doubt  that  when  either 
the  one  or  the  other  is  the  seat  of  a  stubborn  catarrh,  the 
remaining  portion  of  the  uterus  must  become  sooner  or  later 
more  or  less  compromised  in  the  diseased  process. 

Chronic  cervical  endometritis  is  where  the  inflammation 
affects  the  membrane  of  the  neck;  this  has  been  described 
under  the  names  of  cervical  catarrh,  cervical  leucorrhcea,  and 
endocervicitis.  These  terms  are  all  derived  in  composition 
from  the  Latin  word  cervix,  neck. 

The  uterus  is  really  divided  into  two  cavities  that  run 
into  each  other ;  one  of  these  is  the  cavity  of  the  body,  while 
the  other  is  the  cavity  of  the  cervix,  a  fusiform  canal,  meas- 
uring about  one  inch  and  a  quarter  in  length.  The  cervix 
partly  projects  into  the  vagina,  and,  as  a  result,  is  liable  to 
injury  and  irritation,  to  which  the  other  portion  of  the  organ 
is  not  exposed.  Friction  and  other  influences  aggravate  the 
inflammatory  process,  so  that  erosions,  granular  and  cystic 
degenerations,  follicular  ulcers  and  chronic  enlargements, 
become  complications  of  the  catarrhal  inflammation  of  the 
cervix. 

To  return  again  to  a  consideration  of  the  general  aspect 
of  catarrh  of  the  womb,  for  it  is  one  and  the  same  patholog- 
ical process  that  underlies  the  different  forms.  There  is  a 
simplicity  in  the  relation  of  cause  and  effect,  that  will  strike 
the  casual  student  as  one  of  the  most  instructive  lessons 
that  it  is  possible  to  learn,  because  it  also  suggests  the  sim- 
plicity of  the  measures  of  which  persons  can  avail  themselves 
for  the  prevention  or  cure  of  this  affection. 

From  the  physiological  reasons  that  were  mentioned  as 
a  cause  of  endometritis,  it  follows,  as  a  natural  consequence, 
that  the  predisposition  to  catarrh  of  the  womb,  varies  greatly 


212  HOME    TREATMENT. 

with  the  age  of  persons,  so  that  before  the  age  of  puberty, 
at  a  time  when  there  are  no  periodical  congestions  of  the 
womb  from  the  menses,  it  occurs  very  rarely,  while  from  the 
period  of  pubescence,  and  during  the  functional  activity  of 
the  pelvic  organs,  it  is  very  prevalent,  but  at  the  approach 
of  the  menopause  and  sexual  decadence  the  predisposition 
is  again  lost. 

As  far  as  the  character  and  nature  of  uterine  catarrh  is 
concerned,  that  which  in  technical  language  is  termed  the 
pathological  anatomy  is  no  different  from  what  it  is  in  catarrhal 
inflammations  in  other  organs,  so  that  the  remarks  that  were 
made  on  similar  affections  of  other  organs,  apply  with  equal 
correctness  to  catarrh  of  the  uterus. 

There  is,  however,  one  exception  of  which  I  desire  to  re- 
mind the  reader,  and  that  is  a  hemorrhagic  or  granular 
variety  of  inflammation.  In  this  form  of  the  disease  the 
mucous  glands,  and  the  blood  vessels  that  are  distributed 
between  these  glandular  tubules,  increase  or  multiply  enor- 
mously, so  that  I  have  seen  the  mucous  membrane  in  some 
places  a  quarter  of  an  inch  in  thickness.  This  is  the  most 
obstinate  variety  to  yield  to  ordinary  remedies,  and  as  it  oc- 
casions excessive  and  at  times  dangerous  hemorrhage  from 
the  womb,  it  should  not  be  treated  as  conservatively  as  the 
other  varieties  of  which  I  have  spoken. 

There  is  only  one  sure  method  of  cure  that  proved  in  my 
hands  a  success,  and  that  consists  in  the  entire  removal  of 
the  diseased  mucous  surface. 

Dr.  Duvelius  of  Berlin  made  the  discovery  and  demon- 
strated the  fact  that  the  mucous  glands  of  the  uterus  pro- 
ject into  the  muscular  tissue  of  the  organ,  and  that  if  the 
diseased  mucous  membrane  is  removed  or  scraped  off,  down 
to  the  muscular  layer,  a  healthy  membrane  is  regener- 
ated from  the  terminal  glandular  ends  that  remain  im- 
bedded in  the  muscular  tissue.  This  seems  to  have  been 
proved  by  experience,  for  I  have  performed  this  operation 
in  several  obstinate  cases  of  uterine  catarrh,  and  in  several 


ENDOMETRITIS.  213 

instances  the  woman  became  subsequently  pregnant,  which 
proves  at  least  that  the  regenerated  mucous  membrane  is 
capable  of  performing  its  physiological  function,  as  though 
it  never  had  been  interfered  with.  With  proper  antiseptic 
precautions  and  in  skillful  hands,  there  is  absolutely  no 
danger  in  this  operation,  but  the  technique  should  be  thor- 
oughly understood  by  the  operator. 

The  etiology  or  causation  of  uterine  catarrh  resolves 
itself  into  predisposing  and  exciting  causes.  Predisposi- 
tions are  defined  as  that  constitution  or  condition  of  the 
body  which  disposes  it  to  the  action  of  disease  under  the 
application  of  an  exciting  cause.  Persons  who  possess  a 
thoroughly  healthy  constitution  may  be  exposed  to  exciting 
causes  without  the  slightest  danger  of  contracting  diseases, 
to  which  others  who  are  predisposed  fall  victims.  The  pre- 
disposing causes  of  endometritis  are  a  naturally  enfeebled 
constitution;  the  existence  of  a  scrofulous  or  tuberculous 
habit;  impoverishment  of  the  blood  from  chlorosis;  pro- 
longed mental  depression;  improper  and  insufficient  food; 
prolonged  lactation;  frequent  parturition  under  unfavorable 
surroundings;  any  indiscretion  after  delivery  which  inter- 
feres with  the  regeneration  of  the  womb;  styles  of  dress  that 
depress  the  uterus ;  want  of  fresh  air  and  wholesome  exercise- 
Professor  T.  G.  Thomas,  in  his  work  on  Diseases  of 
Women,  asks  the  question  why  most  of  these  influences 
should  produce  this  affection  more  than  others.  His  answer 
is  that  "  they  do  not  do  so."  "Sometimes  they  cause  chronic 
pneumonia;  at  other  times  granular  lids,  and  again  at  other 
times  chronic  endometritis." 

The  exciting  causes  laid  down  by  the  same  eminent 
authority  are  "displacement  of  the  womb;  excessive  or  in- 
temperate coition ;  the  use  of  intra-uterine  pessaries ;  puer- 
peral endometritis;  exposure  or  fatigue  after  confinement; 
efforts  at  production  of  abortion  and  prevention  of  concep- 
tion; vaginitis  either  simple  or  due  to  gonorrhceal  infection; 
painful  obstructive   menstruation;   exposure  during  men- 


214  HOME    TREATMENT. 

struation;  sudden  checking  of  the  menstrual  flow;  and 
tumors  in  the  uterine  cavity  or  walls."  Some  of  the  causes 
here  enumerated  are  much  more  fruitful  of  the  disease  than 
others.  A  woman  whose  constitution  has  been  weakened, 
and  whose  digestion  is  deranged,  by  habits  of  indolence  and 
luxury,  whose  style  of  dress  so  depresses  the  abdominal 
viscera  that  her  uterus  is  pressed  down  into  the  vagina, 
is  particularly  liable  to  develop  a  catarrhal  inflammation 
from  connubial  approaches.  When  these  are  not  without 
pain,  then  there  is  some  predisposition  that  should  be  in- 
quired into  and  righted. 

Uncleanliness  is  not  spoken  of  by  authorities  as  among 
the  causes  of  uterine  catarrh,  yet  it  is  a  very  frequent  one. 
I  have  succeeded  in  curing  so  many  catarrhal  affections  of 
the  vagina  and  uterus  by  simply  advising  the  use  of  vaginal 
irrigations  with  borated  warm  water,  that  I  am  convinced 
that  a  lack  of  personal  cleanliness  is  a  very  prolific  cause  of 
this  affection.  The  accessible  generative  organs,  both  of  the 
female  and  male,  should  be  the  object  of  thorough  rinsings 
so  as  to  reduce  the  possibility  of  infection  to  the  least  degree. 
All  mucous  membranes  have  their  natural  secretions,  and 
these  are  on  light  provocations  abnormally  increased.  The 
vagina  is  always  the  seat  of  more  or  less  bacterial  fermenta- 
tion or  decomposition,  and  if  this  is  retained  for  any  length 
of  time,  it  becomes  not  only  putrid  and  offensive,  but  also  a 
direct  source  of  infection  to  the  mucous  membrane  of  the 
womb.  This  is  more  so  in  a  married  woman,  who  is  ex- 
posed to  the  carelessness  of  her  male  consort,  who  has  not 
been  apprised  of  the  dangers  of  septic  infection,  that  may  be 
innocently  communicated  to  the  wife  by  negligence  of  his 
own  person.  The  wife  is  exposed  to  all  and  every  impurity 
that  the  male  has  on  his  person,  and  thus  she  is  in  constant 
danger  of  having  her  internal  organs  infected,  from  the  outer 
organs  of  the  male. 

There  is  no  doubt  that  many  women  become  infected 
from  this  source,  and  that  obscureand  stubborn  catarrhs  of  the 


ENDOMETRITIS.  215 

vagina  and  womb  are  strictly  traceable  to  personal  unclean- 
liness  of  the  male.  From  the  researches  of  Dr.  Noeggerath 
of  New  York,  it  would  seem  that  in  a  great  many  cases  of 
pelvic  diseases  in  women,  the  affections  can  be  traced  to  a 
latent  gonorrhoea  in  the  male.  This  phrase  means  a  gon- 
orrhoea in  the  male  apparently  cured,  which  even  two  years 
after  the  supposed  cure  infects  a  healthy  vagina,  causing  a 
discharge  and  a  complication  of  the  uterine  mucous  mem- 
brane. I  have  seen  some  cases  that  fully  corroborate  the 
views  of  Noeggerath,  so  that  before  we  put  the  blame  of 
uterine  disease  solely  on  the  shoulders  of  the  wife,  let  us 
find  out  how  much  the  husband  is  to  blame. 

Specialists  in  particular,  but  doctors  in  general,  often 
forget  that  a  woman  has  other  organs  besides  a  womb  and 
ovaries;  there  is  a  relation  of  cause  and  effect  between  val- 
vular lesions  of  the  heart  or  diseases  of  the  lungs,  that  ob- 
struct the  return  of  the  venous  systemic  circulation  to  the 
right  cavity  of  the  heart,  and  catarrhal  diseases  of  the  pel- 
vic organs. 

Biliousness  or  an  affection  of  the  liver,  that  interferes  with 
the  portal  circulation,  or  the  pressure  of  tumors  or  swellings 
on  the  uterine  veins,  are  also  among  the  causes,  while  the 
accumulation  of  feces  or  habitual  constipation  is  often  over- 
looked as  too  trivial  to  deserve  professional  notice,  and  yet 
its  removal  is  often  the  only  successful  means  to  cure  the 
patient. 

The  various  eruptive  and  infectious  diseases,  like  small- 
pox, scarlatina,  measles  or  typhoid  fever,  may  excite  in  their 
course  a  uterine  catarrh,  that  will  remain  behind  as  a 
chronic  complaint,  after  the  acute  affection  has  subsided. 

The  acute  variety  of  endometritis  is  much  more  preva- 
lent as  a  disease  than  is  commonly  supposed,  but,  owing  to 
an  absence  of  specific  or  definite  signs,  pointing  directly  to 
the  mucous  membrane,  which  the  woman  herself  can  recog- 
nize, it  is  generally  mistaken  for  something  else. 

The  disease  begins  with  signs  of  an  active  congestion  in 


216  HOME   TREATMENT. 

the  pelvic  organs;  such  as  drawing  pains  in  the  small  of  the 
back  and  in  the  groins,  and  a  feeling  of  fullness  and  weight 
at  the  bottom  of  the  pelvic  floor.  The  urine  is  voided  with 
pain  and  there  is  a  sensation  of  heat  in  some  parts  of  the 
urethra.  Pressure  on  the  lower  abdominal  region  is  painful, 
and  the  sensitiveness  diminishes  from  the  middle  towards  one 
or  the  other  side.  In  mild  cases  these  symptoms  are  not  ac- 
companied with  fever,  headache  or  a  disturbance  of  the  nerv- 
ous system;  there  may  be  diarrhoea  due  to  reflex  irritation 
of  the  rectum,  and  the  stools  are  accompanied  with  bearing- 
down  pain.  After  three  or  four  days  there  is  usually  a  dis- 
charge of  a  viscid  liquid,  which  in  eight  or  ten  days  be- 
comes creamy,  purulent  and  often  tinged  with  blood.  The 
fluids  that  are  discharged  from  the  vagina  sometimes  be- 
come so  acrid  and  irritating  that,  when  they  come  in 
contact  with  the  skin  of  the  vulva,  abdomen  or  thighs,  it  be- 
comes irritated  and  inflamed,  which  leads  to  excoriations 
and  an  itching,  that  may  spread  over  the  entire  body.  The 
reaction  of  this  discharge  is  either  acid  or  alkaline,  depend- 
ing upon  whether  the  discharge  of  the  uterus  or  that  of  the 
vagina  predominates;  as  the  discharge  from  the  uterus  is 
always  alkaline  and  that  from  the  vagina  always  acid,  there 
is  nothing  of  a  practical  diagnostic  value  in  ascertaining  the 
chemical  reaction  of  the  secretion.  The  vagina  will  gen- 
erally be  found  to  be  hot  and  more  or  less  swollen  as  in  or- 
dinary vaginitis.  The  womb  itself,  however,  will  be  en- 
larged and  sensitive,  while  the  cervix  is  gaping  or  open. 
Through  the  speculum,  it  is  seen  to  be  red  and  congested, 
and  from  the  gaping  mouth  there  issues  a  clear,  albumi- 
nous-looking fluid  or  a  muco-pus. 

In  the  subacute  or  chronic  form  the  symptoms  are  by 
no  means  always  so  prominent  as  to  indicate  the  existence 
of  the  affection,  or  they  are  so  marked,  by  some  of  the  nu- 
merous complications,  which  are  in  the  nature  of  cause  or 
effect,  that  its  recognition  will  become  extremely  difficult. 
The  effect  which  the  disease  has  on  the  general  organism 


ENDOMETRITIS.  217 

varies  greatly  in  different  individuals.  Some  women  of  ro- 
bust appearance  have  an  aggravated  form  of  uterine  catarrh 
without  any  immediate  ill  effects  on  their  nutrition  or  gen- 
eral health.  Other  women  lose  flesh  early  and  become 
weak  and  worn;  they  become  pale,  and  the  face  assumes  a 
yellowish  ashen  hue  with  dark  rings  under  the  eyes. 
Through  reflex  irritation  from  the  nerves  of  the  uterus 
other  nerve  centers  become  involved,  so  that  a  general 
neurasthenia  becomes  developed  with  its  characteristic  con- 
comitants of  neuralgia,  muscular  spasms,  uterine  colic  and 
hysteria. 

With  a  third  class  the  inflammation  spreads  from  the 
lining  membrane  to  the  substance  of  the  womb  itself,  caus- 
ing an  enlargement  of  the  uterus,  which  induces  displace- 
ments and  a  dragging  sensation  in  walking,  pain  in  coitus 
and  painful  defecation.  The  inflammation  does  not  limit 
itself  to  the  womb,  but  an  ichorous  discharge  creates  dis- 
tressing symptoms  of  vaginitis,  inflammation  of  the  bladder, 
and  pruritus  vulvae. 

When  the  uterine  cavity  is  the  seat  of  an  abnormal  vas- 
cular activity,  there  often  exist  symptoms  of  pregnancy  that 
may  mislead  the  patient  or  physician.  Nausea  and  vomit- 
ing are  sometimes  present,  the  darkening  of  the  skin  around 
the  nipples,  and  an  enlargement  and  sensitiveness  of  the 
breasts,  meteorism,  or  a  swelling  of  the  abdomen,  caused  by 
the  accumulation  of  air  in  the  intestinal  canal  from  reflex 
nervous  irritation,  and  when  this  symptom  is  added  to  the 
irregularity  of  menstruation,  it  is  easy  to  fall  into  the  error 
of  diagnosing  pregnancy. 

Sterility  on  the  one  hand,  and  habitual  abortion  on  the 
other,  should  direct  attention  to  the  probable  existence  of 
endometritis.  Very  often  barrenness  has  led  to  an  investi- 
gation of  the  condition  of  the  uterus  which  disclosed  the  ex- 
istence of  the  disease.  A  woman  who  conceives,  and  then 
loses  her  child  in  the  first  months  of  pregnancy,  is  afflicted, 
in  all  probability,  with  a  chronic  endometritis.     In  these 


218  HOME   TREATMENT. 

cases,  where  conception  takes  place,  it  is  to  be  presumed 
that  the  sensitiveness  and  irritability  of  the  inflamed  mu- 
cous membrane  is  not  suitable  for  the  permanent  fixation  of 
the  ovum,  so  that  the  slightest  shock  will  open  the  flood 
gates  of  a  congested  uterus,  and  thus  the  embryo  is  sepa- 
rated from  its  attachment,  and  lost. 

The  cervix  is  sometimes  the  seat  of  a  special  feature  of 
uterine  catarrh,  that  is  due  to  the  chronic  inflammation  of 
the  cervical  mucous  membrane,  stimulating  a  growth  or 
proliferation  of  its  own  tissue  or  structure.  This  growth 
causes  an  enlargement  and  elongation  of  the  entire  cervix, 
and  a  spreading  of  the  lining  membrane  of  the  cervical  canal 
to  the  vaginal  surface  of  the  cervix.  This  encroachment  of 
the  cervical  lining  on  the  vaginal  lining  is  the  displace- 
ment of  the  pavement  epithelial  cells  of  the  vaginal  portion 
by  the  cylindrical  or  columnar  epithelial  cells  of  the  cervical 
canal,  and  this  gives  rise  to  erosions  and  follicular  ulcers. 

These  erosions  have  a  glandular  arrangement,  and  are 
often  mistaken  for  cancerous  or  malignant  growths.  There 
is  no  doubt  in  my  mind,  that  most  of  the  so-called  success- 
ful cures  of  cancer  were  nothing  but  cures  of  erosions. 

The  microscopists,  whose  lively  imaginations  make  them 
see  things  that  do  not  exist,  would  make  us  believe  that 
they  can  take  a  small  section  of  the  suspected  growth,  and 
establish  the  existence  of  cancer  by  microscopical  examina- 
tion; this  is  utterly  impossible,  because  the  cancer  cell  is  no 
different  from  normal  cells,  and  in  erosions  we  often  find  the 
follicles  so  close  to  each  other,  and  their  cells  so  closely 
packed,  one  on  the  other,  that  no  candid  mind  can  say 
whether  it  is  a  malignant  or  an  innocent  growth. 

The  claim  that  "nests  of  epithelium  cells,"  as  the  stereo- 
typed phrase  goes,  constitute  scientific  evidence  of  cancer,  is 
utterly  absurd.  Such  eminent  authority  as  Professor  Arnold, 
of  Heidelberg,  makes  the  assertion  that  positive  diagnosis  of 
cancer,  from  a  small  section  or  scraping,  is  impossible.  I  am 
myself  fully  convinced  of  the  truth  of  this  assertion,  for  while 


ENDOMETRITIS.  219 

I  was  making  microscopical  studies  in  Germany,  I  had 
abundant  evidence  of  the  truth  of  this  statement.  It  is 
indeed  very  unfortunate,  both  for  science  and  suffering 
humanity,  that  as  yet  there  is  no  absolute  means  of  diag- 
nosing cancer  positively,  and  for  that  reason  the  quacks, 
and  those  who  are  not  quacks,  will  continue  to  fleece  their 
victims  for  supposed  cancer. 

I  believe  that  the  cause  of  cancer  is  either  due  to  a  pto- 
maine or  organic  poison  that  is  generated  in  the  body,  or  to  a 
specific  germ  or  bacillus.  If  it  be  due  to  the  latter,  and  the 
germ  theory  of  disease  makes  that  highly  probable,  there  is 
no  doubt  that  a  method  of  staining  will  soon  be  discovered, 
that  will  make  the  specific  microbe  recognizable  in  the  field 
of  the  microscope,  but  as  yet  most  cancer  diagnoses  by  mi- 
croscopy are  only  surmises. 

TREATMENT. 

Continence  in  sexual  intercourse  is  one  of  tne  prerequi- 
sites to  the  successful  treatment  of  all  uterine  diseases. 
This  is  so  often  overlooked  by  those  giving  advice  in  such 
matters,  that  their  otherwise  appropriate  suggestions  for 
treatment  are  frustrated.  The  women  who  are  suffering, 
appreciate  the  value  of  this  interdiction  without  further  ar- 
gument, but  the  average  man  does  not  appear  to  have  the 
common  sense  to  readily  comprehend  that  the  mechanical 
irritation  incident  to  the  sexual  act,  and  the  accompanying 
physiological  congestion,  will  surely  aggravate  an  inflam- 
matory process,  no  matter  of  what  nature.  Men,  whose  an- 
imal instincts  dominate  their  entire  being,  so  that  reason, 
if  they  ever  had  any,  is  dethroned,  should  stop  to  consider 
their  immoderate  conduct,  which  perpetuates  the  suffering 
of  their  wives  from  ailments  which  men  themselves  have 
often  inflicted,  and  for  which  women  are  innocent  martyrs, 

The  acute  variety  of  uterine  catarrh  is  to  be  treated  like 
all  other  acute  inflammatory  diseases. 


220  HOME    TREATMENT. 

The  patient  should  at  once  take  to  bed,  so  that  she  may- 
keep  herself  warm  and  quiet. 

If  the  inflammation  is  due  to  cold  or  exposure  during 
menstruation,  and  the  menstrual  flow  has  been  suddenly 
checked,  then  three  or  four  leeches,  applied  to  the  inguinal 
regions  on  both  sides,  will  be  of  decided  advantage.  Over  the 
lower  abdominal  regions  hot  compresses  should  be  applied ; 
these  are  made  by  wringing  cloths  or  a  large  folded  towel  out 
of  hot  water,  over  which  a  piece  of  oiled  silk,  rubber,  or  oil- 
cloth is  laid  to  retain  the  heat  and  moisture.  At  other 
times,  that  is,  when  the  inflammation  is  not  due  to  cold 
and  a  sudden  stoppage  of  the  menses,  the  application  of  ice 
bags  is  preferable  to  the  hot  compresses,  in  the  manner  else- 
where described. 

The  pains  which  are  felt  in  different  parts  of  the  pelvis 
are  relieved  by  using  the  Femina  vaginal  capsules;  say  one 
every  six  to  eight  hours,  after  a  hot  vaginal  injection  of 
plain  water,  or  a  hot  sitz-bath.  If  there  is  nausea  or  vom- 
iting that  too  is  often  relieved  from  the  soothing  influence 
of  the  capsule  which  allays  the  nervous  irritability. 

Should  the  stomach  not  be  in  a  condition  to  take  nour- 
ishment from  biliousness  or  other  causes,  prescription  No. 
ii  on  page  138  should  be  taken  in  tablespoonful  doses  every 
four  hours  until  the  stomach  is  settled  and  the  system  regu- 
lated; if  any  food  is  taken  it  should  be  between  times  and 
of  a  liquid  nature. 

If  there  is  straining  or  diarrhoea,  I  prefer  to  employ  an 
enema  of  one  pint  of  warm  German  chamomile  tea,  to 
which  half  a  teaspoonful  of  McMunn's  elixir  of  opium  or 
laudanum  is  added.  If  the  pain  and  straining  are  very 
severe,  one  teaspoonful  of  either  is  not  too  much;  by  re- 
questing the  patient  to  retain  the  enema  for  ten  or  fifteen 
minutes,  the  medicine  is  directly  absorbed,  and  the  effect  is 
both  soothing  and  healing.  This  may  be  repeated  several 
times  a  day,  if  the  pain  does  not  subside  after  the  first  in- 
jection. 


ENDOMETRITIS.  221 

The  bowels  are  sometimes  found  to  be  in  an  opposite 
state,  namely,  constipated;  this  must  be  relieved  at  once.  An 
enema  of  warm  soapsuds  answers  the  purpose,  or  a  half- 
tablespoonful  of  warm  water,  in  which  a  half-tablespoonful 
of  glycerine  is  dissolved,  makes  an  excellent  injection  for 
constipation. 

Hot  vaginal  irrigations  should  be  at  once  commenced, 
and  repeated  as  often  as  twice  or  three  times  a  day.  I  al- 
ways dissolve  a  teaspoonful  of  powdered  borax  in  the  hot 
water,  of  which  no  less  than  half  a  gallon  is  used  at  one 
time;  this  is  antiseptic  and  healing.  After  six  or  eight  days, 
once  a  day  will  be  sufficient. 

Chronic  uterine  catarrh  or  uterine  leucorrhcea  does  not 
require  the  active  treatment  which  was  recommended  for 
the  acute  form.  It  depends  quite  often  on  causes,  whose  re- 
moval is  absolutely  necessary  to  the  intelligent  and  successful 
treatment  of  the  affection. 

The  causes  that  have  been  enumerated  must  be  carefully 
and  repeatedly  reviewed,  so  that  each  individual  case  can  be 
traced  to  its  source.  Those  causes  that  are  improbable  must 
be  eliminated  from  those  that  are  probable,  so  that  by  a 
gradual  process  of  exclusion  we  narrow  the  number  down  to 
those  that  actually  exist.  This  simplifies  the  treatment  to 
actual  conditions  that  can  be  intelligently  met. 

Vaginal  irrigations  constitute  in  the  chronic  form  of  the 
disease  an  accepted  and  most  useful  therapeutic  resource. 
There  is  nothing  that  will  ever  contraindicate  a  thorough 
cleansing  of  the  vaginal  canal,  so  that  the  organ  may  not  be 
bathed  in  its  own  morbid  and  irritating  secretion.  It  is  a 
wholesome  auxiliary  to  any  course  of  treatment  that  may  be 
adopted.  It  avoids  self-infection  and  places  the  pelvic  or- 
gans in  the  best  possible  condition  for  the  healing  powers 
of  nature  to  work  out  a  cure. 

If  the  uterine  catarrh  is  the  result  of  a  venous  obstruc- 
tion due  to  a  congested  liver  and  a  general  derangement  of 
the  digestive  apparatus,  then  any  local  treatment  will  be  of 
no  avail  without  first  removing  the  hepatic  derangement. 


222  HOME    TREATMENT. 

Costiveness  or  constipation  is  a  very  common  complaint 
with  women  and  a  very  painful  cause  of  womb  disease,  but 
it  is  so  simple  and  ordinary  in  its  nature  that  the  wise  will 
not  deign  stoop  to  notice  such  trifles,  but  if  it  required  for 
its  removal  a  surgical  operation,  for  which  a  handsome  fee 
is  the  inspiring  motive,  then  we  should  hear  of  it  as  often 
as  we  do  of  lacerations  or  flexions  of  the  cervix  as  a  cause 
of  uterine  catarrh,  and  its  removal  would  then  indeed  be- 
come absolutely  necessary  for  effecting  a  permanent  cure. 

Why  is  it  that  the  treatment  of  uterine  disease  has  de- 
generated into  "professional  faking"  that  is  alike  disgrace- 
ful to  the  profession  and  a  daylight  robbery  of  the  patient. 
A  woman,  for  instance,  is  suffering  from  what  she  supposes 
to  be  womb  disease.  She  consults  a  doctor,  or  what  is  still 
worse,  a  time-serving  specialist,  who  examines  her  and  sees 
at  once  signs  of  uterine  catarrh. 

He  at  once  applies  a  little  tincture  of  iodine  or  carbolic 
acid  diluted  with  glycerine  or  a  solution  of  nitrate  of  silver 
to  the  cervical  canal.  The  woman  is  now  informed  that 
this  application  must  be  repeated  two  or  three  times  a  week, 
for  which  she  must  call  at  the  office  that  number  of  times 
every  week,  for  an  indefinite  period.  At  each  visit  she  is 
subjected  to  the  same  routine  humbuggery  for  local  medica- 
tion, but  does  she  get  any  better?  In  my  early  professional 
experience  I  innocently  and  ignorantly  tried  these  methods 
myself,  and  I  say  no !  But,  as  a  matter  of  fact,  this  constant 
irritation  and  poking  around  and  into  the  womb  will  in- 
flame any  healthy  uterus,  and  much  more  one  that  is  al- 
ready slightly  irritated,  so  that  patients  lose  their  hope  and 
become  convinced  themselves  that  they  are  no  better,  but 
feel  worse  than  when  they  first  commenced  treatment. 

This  inefficient  treatment,  like  the  examination,  is  con- 
jectural and  mechanical  and  therefore  incomplete  and 
unscientific.  The  cause  of  her  entire  trouble  is  never 
approached.  The  woman  suffers  for  years  from  constipation, 
which  also  inclines  her  to  piles,  because  the  pressure  of  the 


ENDOMETRITIS.  223 

hardened  feces  on  the  hemorrhoidal  veins  obstructs  the  flow 
of  venous  blood  and  the  same  pressure  on  the  uterine  veins 
congests  the  mucous  membrane  of  that  organ  and  gives 
rise  to  the  symptoms  of  endometritis.  All  these  conditions 
should  be  inquired  into,  and  many  others,  before  local  treat- 
ment is  decided  on;  simply  running  to  the  doctor's  office 
and  having  these  medical  applications  made  to  the  cervix 
or  canal  of  the  womb  amount  to  nothing;  this,  as  a  general 
rule,  does  only  harm,  and  is  as  superfluous  as  if  one  were  to 
take  a  nasal  douche  of  salt  water  or  some  other  catarrh 
remedy,  whenever  he  feels  a  little  cold  in  the  head. 

The  proper  course  to  pursue  in  this  and  similar  cases  is 
to  prescribe  an  appropriate  diet,  and  regulate  the  bowels. 
It  is  precisely  in  this  way  that  women  who  have  made  the 
rounds  of  the  doctors,  happen  to  take  some  patent  laxative 
or  nostrum  that  relieves  their  constipation,  and  accomplishes 
the  wonderful  cures  of  which  we  often  hear  and  that  were  no 
doubt  Godsends  to  the  sufferers  that  were  cured,  after  all  the 
first-class  doctors  failed.  By  far  the  greatest  proportion  of 
cases  of  uterine  catarrh  are  of  a  simple  and  transient  nature 
and  are  only  intensified  by  probing  and  local  treatment. 

When  I  first  began  the  practice  of  medicine,  I  made  the 
same  mistake  in  following  the  advice  of  books  and  those 
who  should  have  known  better,  for  they  have  had  ample 
opportunity  to  be  convinced  of  the  fallacy  of  these  local 
measures  in  the  great  majority  of  cases,  but  some  minds  are 
incompetent  to  learn  from  experience,  for  that  requires  close 
observation,  and  logical  reasoning. 

I  soon  discovered  that  the  catarrhal  inflammations  got 
worse,  in  proportion  to  the  trouble  and  pains  I  took  to  treat 
them  locally,  so  that  I  became  ashamed  of  my  ill  success 
and  abandoned  the  local  treatment  entirely,  and  this  I  shortly 
discovered  was  the  means  of  curing  them.  Instead,  I  simply 
directed  patients  to  rinse  themselves  with  quite  warm  salt 
water,  that  is,  a  tablespoonful  of  ordinary  cooking  salt  dis- 
solved in  a  gallon  of  water.     Now  I  prefer  Femina  antiseptic 


224  HOME    TREATMENT. 

lotion  to  the  same  quantity  of  water,  which  has  greater  heal- 
ing properties  than  either  pulverized  borax  or  common  salt. 
I  particularly  advised  them  to  keep  their  feet  and  lower  ex- 
tremities warm,  regulating  their  diet  and  keeping  their 
bowels  open.  I  noticed  that  the  patients  began  to  improve, 
and  that  the  improvement  continued  until  they  were  fully 
restored  to  health  and  vigor.  This  method  of  treatment 
would  not  keep  an  office  overcrowded  with  deluded  patients, 
but  it  proved  far  more  satisfactory  to  all  concerned  than 
meddlesome  measures,  and  illustrated  one  of  the  most  com- 
mon abuses  to  which  suffering  women  are  liable. 

In  taking  a  laxative  patients  must  feel  their  way  as  to  the 
proper  dose  to  take  in  their  own  individual  case;  constitu- 
tions differ  very  much  in  this  respect,  so  that  it  is  impossi- 
ble to  lay  down  one  and  the  same  rule  for  different  persons. 
It  is  not  good  practice  to  give  medicines  three  or  four  times 
a  day  in  cases  of  habitual  constipation,  for  it  is  liable  to  de- 
range the  digestion  and  interfere  with  the  appetite.  The 
proper  method  is  one  dose  at  bedtime  and  this  should  be 
increased  or  diminished  until  the  suitable  dose  of  the  remedy 
has  been  ascertained;  when  this  is  accomplished,  the  dose  of 
the  remedy  should  be  gradually  lessened,  a  few  drops  every 
day,  till  it  can  be  entirely  dispensed  with.  If  the  ordinary 
dose  fails  to  relieve  the  bowels,  an  additional  treatment  of 
glycerine  enema  at  or  about  the  time  that  the  stool  is  to 
take  place  is  to  be  employed.  One  or  two  teaspoonfuls  of 
glycerine  should  be  diluted  with  an  equal  quantity  of 
water,  and  by  means  of  a  hard  rubber  piston  syringe 
thrown  into  the  rectum.  The  stimulating  effect  of  glycerine 
on  the  nerves  and  mucous  membrane,  materially  assists  in 
relieving  the  torpor  of  the  rectum,  which  has  become  insen- 
sitive to  the  irritation  of  its  natural  contents. 

Patients  who  are  costive  must  get  into  regular  habits  of 
relieving  themselves,  that  is,  have  a  regular  hour  every  day 
when  to  go  to  stool,  then  the  medicine  will  in  time  cure  the 
most  obstinate  cases  of  constipation,  otherwise  it  is  impos- 


ENDOMETRITIS.  225 

sible  to  cure  it.  It  takes  a  constant  amount  of  effort  to  get 
well,  so  that  those  who  are  too  indolent  or  think  it  too  troub- 
lesome to  exert  themselves,  cannot  hope  to  recover. 

If  there  is  great  debility  and  impoverishment  of  the 
blood,  then  I  would  advise  prescription  No.  1,  which  are  the 
iron  pills,  of  which  three  pills  should  be  taken  three  times  a 
day.  The  moderate  use  of  wine,  either  claret  or  Riesling 
with  the  food,  instead  of  tea  or  coffee,  is  very  beneficial,  be- 
tween meals  a  glass  of  Porter  to  relieve  the  gone-in  feeling, 
until  the  system  has  recovered  sufficient  strength  to  do  with- 
out it,  that  is  when  ordinary  exertions  are  no  longer  a 
burden. 

The  small  percentage  of  cases  that  do  not  yield  to  the 
above  treatment,  become  legitimate  subjects  for  an  honest 
specialist,  for  there  may  be  extensive  lacerations  of  the  cer- 
vix that  require  surgical  treatment,  or  an  elongated  cervix 
that  should  be  amputated,  or  a  granulated  hypertrophied 
membrane  of  the  uterine  cavity  that  should  be  scraped  out ; 
all  these  operations  are  without  danger  if  the  operator  has 
thoroughly  mastered  the  details  of  antiseptic  surgery  and  has 
the  manual  skill  to  do  the  work  properly. 


15 


CHAPTER  XVIII. 

THE  NATURAL  POSITION    OF   THE    UTERUS   AND 
HOW  IT  IS  SUPPORTED. 

The  uterus  is  not  a  stationary  fixture  in  the  female  pel- 
vis, but  enjoys  a  mobility  within  physiological  bounds, 
which  in  itself  explains  the  great  diversity  of  opinions 
which  may  and  do  arise  respecting  the  normal  or  abnormal 
position  of  the  womb  in  any  given  case. 

"When  the  surrounding  organs  and  tissues  of  the  womb 
are  in  a  healthy  condition,  and  the  abdominal  walls  are  not 
compressed  by  the  weight  and  pressure  of  skirts,  nor  the 
liver  or  diaphragm  forced  down  towards  the  pelvis  by  a  tight- 
fitting  corset,  the  organ  is  movable  in  every  direction,  with- 
out the  slightest  pain  or  suffering. 

The  uterus  is  not  tied  down  by  any  ligaments,  as  one 
might  imagine  from  a  description  of  the  several  ligaments 
that  constitute  only  in  a  small  degree  its  support,  for  it 
changes  its  position  in  retching,  coughing,  breathing,  sing- 
ing, walking  and  all  other  violent  movements. 

The  question  now  naturally  arises :  What  is  the  normal 
position  of  the  uterus,  and  what  constitutes  its  natural  sup- 
ports? To  answer  this  interrogation  is  to  controvert  one  of 
the  most  baneful  fallacies  in  gynecological  practice,  for  the 
amount  of  torturing  and  useless  doctoring  to  which  .women 
are  constantly  subjected,  owing  to  some  fancied  displacement 
of  the  womb,  illustrates  the  force  of  precedent  or  of  accepted 
opinions,  that  were  fortified  by  years  of  erroneous  teaching. 

It  was  supposed  until  quite  recently  that  when  the  body 
of  the  womb  was  inclined  horizontally  forwards,  this  was 
unnatural  or  a  sign  of  disease,  until  Prof.  B.  S.  Schultze, 

(226) 


POSITION   AND   SUPPORT   OF   THE   UTERUS.  227 

director  of  the  gynecological  clinic  of  Jana,  successfully 
controverted  this  doctrine.  In  his  work  "Die  Pathologie  und 
TJierapie  der  Lageversenderungeii  der  Gebsermutter,"  which  is 
the  most  classical  work  extant  on  displacements  of  the  uterus, 
says:  "  From  the  post-mortem  findings  it  was  inferred  that 
the  uterus  occupied  in  the  living  woman  the  same  position 
as  in  the  cadaver;  such  an  assumption  did  not  take  into  ac- 
count the  actions  of  the  muscles  on  the  position  of  the  uterus 
in  the  living  subject  nor  the  intra-abdominal  pressure  which 
is  entirely  absent  after  death,  so  that  the  dead  organ  natu- 
rally gravitated  backward  after  the  remains  had  lain  for 
several  days  on  the  back."  Another  observer,  Dr.  Hach, 
found  in  a  number  of  cases  that  he  had  examined  during 
life,  the  uteri  bent  forward  or  antiflexed;  twenty-four  hours 
after  death  he  discovered  the  same  uteri  in  an  opposite  di- 
rection or  retroflexed. 

This  and  similar  subsequent  researches  have  demon- 
strated the  fact  that  when  the  body  of  the  womb  rests  on 
the  bladder  it  is  not  in  an  abnormal  position  as  formerly 
supposed  and  called  anteversion  or  anteflexion,  but  that  it  is 
natural  for  it  to  be  so,  and  wThen  the  body  is  elevated  and 
its  axis  forms  an  obtuse  angle  with  the  horizon,  the  inclina- 
tion is  a  post-mortem  condition. 

With  these  precursory  remarks  I  am  now  able  to  answer 
the  first  clause  of  our  query,  and  would  say  that  the  uterus 
is  in  its  normal  position  when  its  long  axis  is  nearly  parallel 
to  the  horizon  or  at  right  angles  with  the  perpendicular  or 
long  axis  of  the  body.  The  normal  position  of  the  uterus 
is  modified  when  the  bladder  is  full  or  distended,  for  this 
lifts  the  body  of  the  uterus  upwards,  thus  temporarily  mak- 
ing an  acute  angle  with  the  vertical  axis  of  the  body,  which 
was  formerly  considered  to  be  the  permanent  and  natural 
pose  of  the  organ. 

In  referring  to  the  bony  pelvis,  Plate  I,  it  will  be  ob- 
served that  the  same  is  in  the  nature  of  a  canal,  for  the  pas- 
sage of  the  child  into  the  world.    At  other  times  than  dur- 


228  HOME    TREATMENT. 

ing  the  child-bearing  process,  this  canal  must  be  effectually- 
closed  to  perfectly  retain  its  contents.  To  accomplish  this 
purpose  it  is  provided  with  a  bottom  or  floor,  which  is  to 
give  this  necessary  support,  not  only  to  the  organs  that 
the  pelvic  cavity  contains  but  also  to  the  abdominal  viscera 
that  are  superimposed  upon  them.  In  order  to  accomplish 
this,  its  outlet  must  be  as  effectually  closed  as  the  bottom  of 
a  box  or  barrel  in  which  material  things  are  stored  for  the 
purpose  of  carrying  them  from  place  to  place.  In  the  hu- 
man subject  this  bottom  is  called  the  pelvic  floor,  because 
it  serves  the  purpose  of  a  bottom  or  floor  to  the  pelvic  canal. 

The  pelvic  floor  is  not  a  simple  structure  but  a  complicated 
arrangement  of  organs  and  tissues.  If  we  begin  to  examine 
it  from  below  upwards,  we  first  have  its  outer  covering  in 
the  skin ;  then,  the  superficial  and  deep  fascias,  the  triangu- 
lar ligament  of  the  bladder  and  a  group  of  interlacing  mus- 
cles. The  organs  that  enter  into  the  composition  of  the 
pelvic  floor  and  interwoven  with  the  preceding  structures, 
are  the  bladder,  the  vaginal  walls,  the  rectum  and  connec- 
tive tissue.     Examine  Plate  II. 

Through  this  floor  there  are  several  openings,  which  are 
guarded  by  a  special  set  of  constrictor  muscles  that  are 
termed  sphincters.  These  are  sufficiently  strong  in  the  blad- 
der and  rectum  but  in  the  vagina  they  would  be  entirely 
insufficient  to  close  this  canal  effectually. 

The  vagina,  or,  for  our  purpose,  it  will  be  clearer  if  we  say 
"vaginal  canal,"  divides  the  pelvic  floor  into  an  anterior  and 
posterior  segment,,  and  it  is  by  means  of  this  division  that 
the  whole  structure  of  the  pelvic  floor  is  weakened ;  this  will 
be  perceived  at  a  moment's  reflection,  when  we  compare  it 
with  the  pelvic  floor  of  the  male,  who  has  no  vagina;  and  for 
this  reason  men  are  never  troubled  with  the  prolapses  to 
which  women  are  liable.  Nature,  however,  has  made  an 
attempt  to  compensate  this  physical  defect  in  a  manner  that 
reduces  the  weakness  occasioned  by  the  vaginal  canal  to  its 
minimum.     The  vaginal  canal  does  not  enter  the  pelvic 


POSITION   AND   SUPPORT   OF   THE    UTERUS.  229 

■cavity  in  a  directly  upward  or  perpendicular  course,  but 
obliquely  upwards  and  backwards,  as  may  be  seen  by  re- 
ferring to  Plate  II.  The  result  is  that  the  intra-abdominal 
pressure  falls  on  the  vaginal  walls  from  above,  and  thus 
compresses  and  approximates  the  anterior  and  posterior 
walls  of  the  vagina  to  each  other,  so  that  it  constitutes  a 
self-closing  valve,  but,  notwithstanding  all  these  provisions, 
this  slit  or  opening  through  the  pelvic  floor  still  remains  the 
weakest  point  of  the  inclosure  for  the  pelvic  and  abdominal 
viscera.  When  the  causes  are  sought  that  underlie  the  va- 
rious displacements  of  the  uterus,  they  are  generally  to  be 
found  in  an  impairment  of  the  pelvic  floor,  through  some 
changes  or  accidents  that  are  peculiar  to  pregnancy  and  de- 
livery. 

As  we  are  also  to  inquire  in  the  succeeding  chapter  into 
the  displacements  to  which  the  womb  is  liable,  it  would 
greatly  assist  our  understanding  if  we  first  got  an  idea  of 
what  constitutes  the  natural  supports  of  the  uterus?  The 
word  ligament  is  defined  as  anything  that  ties  or  unites  one 
thing  or  part  to  another;  a  bandage;  a  bond.  This  is  the 
idea  in  the  popular  mind,  so  that  when  the  terms  broad  and 
round  ligaments  of  the  womb  are  employed  it  is  supposed 
that  they  are  for  the  same  purpose  for  which  ligaments  are 
usually  intended.  This  is,  unfortunately  for  a  clear  under- 
standing of  the  subject,  a  great  mistake,  because  these  liga- 
ments are  an  exception  to  the  generally  accepted  meaning  of 
the  term,  for  they  neither  tie  nor  support  the  uterus  in  its 
natural  position.  One  may  readily  imagine  that  this  erron- 
eous conception  would  lead  to  a  mistaken  course  in  the 
treatment  of  most  cases  of  displacements,  because  too  much 
importance  is  bestowed  upon  structures  that  have  no  physio- 
logical bearing  on  the  disease. 

Drs.  Hart  and  Barbour,  of  Edinburgh,  in  their  "  Manual 
of  Gynecology,"  which  is  the  most  scientific  and  practical 
work  that  has  lately  appeared  in  the  English  language,  have 
this  to  say  in  speaking  of  the  support  of  the  uterus:  "The 


230  HOME    TREATMENT,  I 

question  of  the  support  of  the  uterus  is  still  disputed.  The 
broad  and  round  ligaments  have  nothing  to  do  with  its 
support,  they  are  only  useful  as  giving  fixed  points  for  the 
contracting  uterine  muscles  during  parturition.  The  chief 
support  is  the  compact  unbroken  pelvic  floor,  on  which  the 
uterus  rests  just  as  one  sits  on  a  chair.  It  is  the  whole  pel- 
vic floor  that  supports  the  uterus  and  viscera,  not  the  peri- 
neum alone."  The  perineum  (see  anatomical  Plate  II)  is 
only  a  small  though  strong  part  of  the  pelvic  floor.  If  the 
reader  will  now  patiently  review  the  organs  that,  together 
with  the  other  tissues,  constitute  this  floor,  and  this  can  be 
most  profitably  done  by  studying  Plate  II,  there  can  be  no 
confusion  of  ideas  whatever.  In  the  following  pages  I  have 
occasion  to  refer  to  what  is  understood  by  the  term  pelvic 
floor. 


CHAPTER  XIX. 

PROLAPSUS  OR  FALLING  OF  THE  WOMB. 

If  one  desires  to  familiarize  himself  with  a  thorough 
understanding  of  this  subject,  it  is  absolutely  necessary  to 
bear  in  mind  what  was  said  of  the  natural  support  of  the 
uterus,  for  unless  one  has  a  full  knowledge  of  the  foundation 
of  a  structure,  how  can  he  comprehend  its  defects  and 
remedy  them  when  the  structure  falls?  The  workman  who 
potters  on  a  building  that  has  shifted  from  its  foundation 
without  first  devising  means  for  a  new  and  solid  basis  for 
it  to  rest  upon,  would  be  considered  a  fool.  The  term  "  fall- 
ing of  the  womb"  has  no  longer  the  significance  that  it 
once  had,  for  it  is  only  a  symptom  that  something  is  wrong, 
and  in  the  present  state  of  our  knowledge  it  is  misleading 
and  a  misnomer,  inasmuch  as  it  conveys  the  impression 
that  it  is  due  to  an  affection  of  the  uterus,  when  as  a  matter 
of  fact  it  is  not  due  to  any  disease  of  the  womb  at  all.  If 
the  prolapsed  uterus  has  become  involved  in  a  morbid 
process,  it  is  the  result  of  the  abnormal  conditions  that  have 
brought  the  prolapsus  about,  and  in  which  the  uterus  was 
in  no  way  concerned. 

Professor  Schroeder,  of  Berlin,  takes  a  similar  view  of 
these  cases,  and  he  groups  into  one  chapter  three  distinct 
varieties,  yet,  because  one  is  depending  on  the  other,  he 
considers  them  all  as  one  disease.  These  affections  are: 
prolapse  or  falling  of  the  womb ;  prolapse  or  falling  of  the 
vagina,  and  an  inflammatory  elongation  or  hypertrophy  of 
the  cervix  or  neck  of  the  womb.  He  says  "  that  the  dis- 
placement of  the  womb  is  very  seldom  a  primary  affection, 
but  that  it  is  oftener  the  consequence  of  a  prolapse  or  falling 
of  the  vagina,  and  a  giving  way  of  other  structures,  or  of  the 

(231) 


232  HOME   TREATMENT. 

pelvic  floor,  and,  as  such, '  falling  of  the  womb '  cannot  be 
properly  separated  into  an  individual  affection  of  the 
womb." 

Falling  of  the  vagina  is  principally  due  to  a  widening 
of  the  vaginal  canal,  a  relaxation  of  its  walls,  and  injuries 
or  lacerations  of  the  pelvic  floor.  Lacerations  of  the  peri- 
neum generally  occur  during  confinement,  in  which  the 
vagina  tears  through  the  vaginal  orifice  backwards  towards, 
or  into,  the  rectum.  This  so  weakens  the  pelvic  floor  that 
it  becomes  inadequate  to  support  the  pelvic  organs  and 
tissues,  and  this  predisposes  to  all  the  varieties  of  prolapsus 
that  have  been  enumerated  above.  It  is  during  the  period 
of  gestation  that  the  vagina  grows  considerably  longer  and 
wider.  In  the  latter  months  of  pregnancy  the  womb  as- 
cends and  its  body  inclines  greatly  forwards,  which  naturally 
tilts  the  cervix  high  up  in  the  pelvis,  and  also  draws  that 
portion  of  the  vagina  to  which  the  cervix  is  attached  with 
it,  but  notwithstanding  this  upward  dragging  of  the  vagina, 
the  lower  portion  of  the  vaginal  canal  has  so  augmented 
its  proportions  that  it  often  protrudes  between  the  lips  of 
the  vulva  during  the  last  period  of  gestation.  The  normal 
relation  of  the  vagina  to  the  neighboring  organs  is  more  or 
less  disturbed,  that  is,  its  attachment  to  the  bladder  and 
rectum  is  stretched  and  loosened,  so  that  under  the  most 
favorable  circumstances  the  mucous  membrane  of  the  lower 
portion  of  the  vagina  falls  out  of  the  vulva  or  prolapses,  of 
course  in  the  majority  of  cases  only  in  such  a  degree  that  it 
neither  inconveniences  nor  is  it  noticeable  by  the  pregnant 
woman. 

Immediately  after  confinement,  in  a  healthy  state  of 
affairs,  nature  should  rectify  these  abnormal  proportions, 
that  were  only  designed  by  her  to  serve  a  temporary  pur- 
pose, namely,  to  accommodate  the  child  and  provide  for  its 
safe  passage  into  the  world.  Medical  writers  have  invented 
a  special  term  to  designate  this  process  of  regeneration, 
namely,  involution.    This  means  to  infold  or  grow  less  so 


PROLAPSUS   OR    FALLING   OF   THE   WOMB.  233 

as  to  assume  the  former  natural  proportions  of  organs. 
Unfortunately,  nature  is  often  contravened  in  her  whole- 
some regenerative  purpose,  by  adventitious  circumstances 
that  completely  frustrate  her  intentions,  and  the  reparative 
process  being  thus  balked,  the  organs  and  tissues  remain  in 
their  abnormal  proportions,  which  constitutes  now  a  disease, 
and  this  uncompleted  effort  to  repair  is  termed  sub-involution. 

It  takes  at  least  from  six  weeks  to  three  months  after 
delivery  for  the  reparative  process  or  involution  of  the  or- 
gans and  tissues  to  be  completed.  And  women  cannot  ex- 
ercise too  much  care  after  confinement  to  avoid  any  possible 
check  to  the  regenerative  process.  If  the  involution  has  been 
arrested,  the  vagina  retains  its  large,  flabby  proportions,  so 
that  its  relaxed  walls  naturally  protrude  or  prolapse,  and 
that  entails  all  the  other  consequences. 

Intra-abdominal  pressure  should  be  explained  in  con- 
nection with  this  subject,  for  it  constantly  encourages  pro- 
lapsus of  the  organs  under  consideration.  By  that  is  meant 
the  pressure  which  the  contents  of  the  abdominal  cavity 
exert  on  its  walls,  and  this  is  greatest  at  its  most  dependent 
part,  which  is  the  pelvic  floor.  This  pressure  is  continuous 
on  the  organs  of  the  pelvic  floor  while  the  woman  is  stand- 
ing, and  greatest  at  the  point  of  least  resistance,  which  is  the 
relaxed  and  enlarged  vagina,  so  that  it  bulges  out  at  the 
vaginal  orifice.  When  the  patient  resumes  a  recumbent 
position,  this  point  is  greatly  relieved  from  pressure,  and 
the  vagina  may  regain  its  normal  relations,  but  whenever 
the  woman  is  in  the  upright  position,  the  intra-abdominal 
pressure  will  again  force  the  weakened  pelvic  floor  and 
vaginal  walls  downwards.  After  a  time  the  prolapse  no 
longer  subsides  after  the  pressure  is  reduced,  for  the  tissues 
have  lost  their  recuperative  power,  and  the  prolapse  be- 
comes permanent.  When  the  intra-abdominal  pressure  is 
supplemented  by  the  action  of  the  diaphragm  and  the  con- 
traction of  the  abdominal  muscles,  as  occurs  in  a  long  par- 
oxysm of  coughing,  repeated  vomiting,  and  inordinate  and 


234  *  -HOME   TREATMENT. 

prolonged  bearing  down  at  stool,  a  prolapse  may  take  place 
quite  suddenly,  precisely  as  in  a  rupture  or  hernia,  and  for 
these  reasons  some  authorities  (Drs.  Hart  and  Barbour,  of 
Edinburgh)  have  described  prolapsus  of  the  womb  as  a  sacro- 
pubic  hernia. 

A  permanent  distension  of  the  bladder  or  an  accumula- 
tion of  feces  in  the  rectum  facilitates  the  development  of  a 
prolapse  of  the  vagina,  because  the  former  pushes  the  an- 
terior wall  of  the  vagina  downwards,  while  the  latter  de- 
presses the  vaginal  wall. 

A  large  or  subinvoluted  uterus  is  by  some  considered  as 
a  fruitful  cause  of  prolapse ;  this  Professor  Schroeder  denies, 
and  I  am  convinced  from  experience  that  he  is  right.  A 
uterus  that  is  simply  enlarged  is  not  inclined  to  prolapse, 
because  the  enlarged  pregnant  uterus  never  prolapses  if  the 
pelvic  floor  is  in  a  normal  condition.  But  a  chronic  en- 
dometritis or  uterine  catarrh  may  in  time  involve  the  vagina 
in  a  vaginal  catarrh  and  this  may  induce  a  prolapse.  A 
chronic  vaginal  catarrh  or  leucorrhcea  can  so  relax  the  vag- 
inal walls  that  its  lower  folds  protrude  from  the  vaginal 
orifice. 

Women  who  are  beyond  the  change  of  life  and  in  whom 
the  lost  elasticity  of  the  tissues  and  a  general  absorption  of 
fatty  and  connective  tissue  has  destroyed  the  natural  sup- 
port which  retains  the  vaginal  walls,  may  be  annoyed  with 
partial  prolapses  of  the  vagina. 

The  most  aggravated  types  of  prolapses  are  found  among 
the  working  classes,  who  cannot  avail  themselves  of  the 
comforts  and  hygiene  of  the.  lying-in  chamber  that  are  so 
essential  for  a  complete  and  permanent  recovery. 

Elongation  or  hypertrophy  of  the  cervix  of  the  uterus  is 
the  third  variety  of  prolapses  that  Professor  Schroeder  in- 
cludes in  the  group.  This  form  is  consequent  upon  a  fall- 
ing or  prolapse  of  the  vagina,  and  it  occurs  in  the  following 
manner.  The  body  of  the  uterus  being  retained  by  its 
natural  supports  or  by  adhesion  of  a  former  inflammatory 


PROLAPSUS    OR    FALLING    OF    THE    WOMB.  235 

process  in  the  pelvic  cavity,  remains  stationary  where  it 
naturally  belongs,  while  the  upper  end  of  the  vaginal  canal 
being  attached  to  and  surrounding  the  cervix  or  neck  of  the 
womb,  gradually  draws  or  stretches  the  cervix  out,  so  that 
it  grows  one  or  two  inches  longer  than  it  is  natural  for  it  to 
be.  The  cervix  of  the  womb  projects  under  these  circum- 
stances down  into  the  vagina,  and  in  some  cases  it  may  be 
seen  between  the  lips  of  the  vulva.  This  condition  is  mis- 
taken for  falling  of  the  womb,  when  in  reality  it  is  a  falling 
of  the  vagina  with  an  incidental  lengthening  of  the  cervix 
of  the  womb.  To  recognize  and  make  these  distinctions  is 
of  the  greatest  practical  importance,  for  thus  alone  can  the 
measures  adopted  for  the  relief  of  these  distressing  com- 
plaints be  successful. 

The  symptoms  of  prolapsus  grow  principally  out  of  the 
changed  relations  of  the  uterus  to  the  surrounding  organs 
and  tissues.  The  mechanical  interference  and  pressure  of 
the  womb  on  neighboring  parts,  and  the  changes  that  are 
induced  in  the  organ  itself  by  the  altered  circulation  in  its 
tissues,  cause  the  inflammatory  enlargement  or  hypertrophy 
that  is  characteristic  of  one  variety  of  the  affection. 

In  some  persons  the  development  of  the  disease  is  so 
gradual  that  it  has  progressed  for  years  without  any  serious 
inconvenience  and  the  symptoms  that  did  exist  were  gener- 
ally attributed  to  other  causes.  In  the  course  of  time  there 
is  such  a  combination  of  morbid  processes,  like  painful  men- 
struation, inflammatory  enlargement  of  the  womb  and  ero- 
sions of  the  cervix  with  profuse  leucorrhoea,  as  to  render 
the  parts  painful  and  sensitive  to  pressure  and  friction. 
These  symptoms  excite  in  the  end  suspicion,  so  that  the 
sufferer  may  seek  advice  that  will  reveal  to  her  the  real  con- 
dition of  her  case. 

Other  signs  of  these  affections  are  a  dragging  down  or  a 
feeling  as  though  a  weight  pulled  the  pelvic  organs  down- 
wards; there  is  also  traction  on  the  bladder,  making  this  vis- 
cus  exceedingly  irritable,  so  that  there  is  a  frequent  desire 


236  HOME    TREATMENT. 

to  micturate;  the  rectum  suffers  also  from  similar  traction. 
There  is  another  sign  that  is  very  often  present,  and  partic- 
ularly in  the  early  stages,  and  this  is  a  feeling  as  if  the  va- 
gina was  open ;  this  is  due  to  the  relaxation  of  the  vaginal 
walls.  Walking  for  any  distance  becomes  burdensome  and 
causes  great  fatigue ;  pain  in  the  back  and  loins  is  hardly 
ever  absent.  There  is  an  inability  to  lift  weights,  because 
the  pelvic  floor  cannot  endure  the  extra  strain  that  is  super- 
imposed on  the  intra-abdominal  pressure;  ascending  or  de- 
scending stairs  aggravates  the  symptoms  much  more  than 
walking  on  the  level  floor. 

TREATMENT. 

This  must  be  directed  to  the  accomplishment  of  two 
ends,  without  which  no  relief,  much  less  a  cure,  is  possible? 
and  these  are,  first,  to  return  the  displaced  organ  to  its  nor- 
mal position,  and,  secondly,  to  retain  it  there.  The  course  first 
indicated  is,  as  a  rule,  not  difficult  to  follow  out;  in  fact,  if 
the  patient  is  placed  in  a  favorable  position,  the  uterus  re- 
places itself  through  the  natural  forces  of  traction  and  grav- 
itation, unless  it  has  become  so  enlarged  that  it  is  a  physical 
impossibility. 

The  "knee-chest"  or  "  knee-elbow  posture"  is  the  term  that 
has  been  given  to  this  position,  and  it  is  assumed  in  the  fol- 
lowing manner. 

The  woman  gets  down  on  her  knees,  the  thighs  being 
kept  in  an  upright  or  vertical  line;  the  object  of  this  is  to 
keep  the  pelvis  as  high  as  possible,  while  the  chest  is  bent  or 
inclined  forwards  until  the  head  rests  on  the  floor;  the  shoul- 
ders must  be  as  low  to  the  floor  as  it  is  possible  for  the  pa- 
tient to  endure. 

This  position  at  once  reduces  the  intra-abdominal  pres- 
sure on  the  pelvic  floor  to  the  least  degree,  and  besides  this, 
the  abdominal  viscera  gravitating  towards  the  diaphragm^ 
the  prolapsed  uterus  and  surrounding  tissues  are  drawn  up- 
wards and  forwards  with  it.  If  the  prolapse  was  complete 
or  nearly  so,  so  that  the  organ  almost  protruded  through 


PROLAPSUS  OR  FALLING  OF  THE  WOMB.       237 

the  vulva,  then  the  patient  should  retain  this  posture  for  ten 
or  fifteen  minutes  before  an  attempt  is  made  to  replace  the 
organ;  for  the  intense  congestion  should  be  first  allowed  to 
subside. 

No  sudden  or  violent  force  should  be  employed,  but  a 
gentle,  steady  pressure.  In  cases  where  the  organ  has  simply 
descended  into  the  vagina,  the  knee-chest  posture  alone  will 
replace  the  uterus.  Those  displacements  that  are  due  to  a 
chronic  catarrh  of  the  vagina  are  particularly  suitable  for 
home  treatment,  because  the  patient  can  surely  cure  her 
vaginal  catarrh,  and  combining  with  this  the  knee-chest  pos- 
ture, which  should  be  practiced  night  and  morning,  for  at 
least  ten  minutes,  and  until  the  catarrhal  inflammation  has 
entirely  subsided,  she  has  at  her  command  the  most  useful 
and  beneficial  resource  to  accomplish  a  cure. 

If  the  reader  will  refer  to  page  179  and  note  carefully  what 
was  said  in  this  connection,  she  will  learn  that  the  phrase  jail- 
ing of  the  womb  is  sometimes  nothing  more  or  less  than  a 
relaxation  of  the  vaginal  walls  that  is  due  to  a  chronic  ca- 
tarrh of  the  vagina.  It  is  quite  natural  that  it  should  be  so, 
for  if  the  structures  that  make  up  the  pelvic  floor  lose  their 
tonicity  and  strength,  the  womb  must  naturally  descend.  If 
we  now  succeed  in  temporarily  replacing  the  organ  by  assum- 
ing the  knee-chest  position,  and  in  the  meantime  cure  the 
catarrh  and  inflammation  the  patient  must  get  well.  The 
reader  is  again  referred  to  the  chapter  on  vaginal  catarrh. 

The  fatigue  or  lassitude  which  makes  every  physical 
effort  of  some  patients  a  great  hardship,  can  be  greatly  re- 
lieved, if  not  cured,  by  this  formula. 

no.  x. 

Take:  Tincture  of  nux  vomica 2  drams 

Fluid  extract  of  ergot 4  drams 

Fluid  extract  of  golden  seal 1  ounce 

Compound  elixir  of  calisaya  sufficient  to 
make 8  ounces 


238  HOME    TREATMENT. 

Directions:  A  tablespoonful  three  times  a  day,  between 
meals. 

When  the  prolapse  is  due  to  some  of  the  structural  de- 
fects that  were  enumerated  in  the  causation  of  displace- 
ments, and  that  were  traced  to  the  accidents  of  childbirth, 
then  no  permanent  relief  can  be  hoped  for,  until  these  de- 
fects are  remedied. 

Pessaries  or  rings  that  are  introduced  into  the  vagina 
for  the  purpose  of  stretching  or  spreading  out  the  relaxed 
folds  of  the  vagina,  that  they  cannot  prolapse  or  fall  down, 
and  thus  indirectly  support  the  uterus,  were  suggested  by 
the  ancient  fathers  of  medicine.  In  view  of  the  fact  that 
they  were  wholly  ignorant  of  the  causes  that  were  responsi- 
ble for  prolapses,  the  remedy  was  quite  practical  and  in- 
genious, but  to-day,  when  we  are  acquainted  with  the  causes 
that  operate  in  bringing  the  prolapse  about,  they  are,  to  my 
mind,  a  very  unsatisfactory  makeshift,  and  afford  only  a 
temporary  amelioration. 

A  woman  who  is  compelled  to  wear  a  ring  or  pessary  is 
certainly  not  well,  and  if  she  has  any  hard  work  to  do  or 
must  be  on  her  feet  a  great  deal,  the  pessary  will  sooner  or 
later  so  irritate  the  vagina  that  it  must  be  removed.  Be- 
sides this,  I  always  contended  that,  in  the  long  run,  this 
extra  strain  on  the  vaginal  walls  would  only  relax  them 
more,  and,  instead  of  ever  being  able  to  dispense  with  the 
use  of  a  pessary,  she  must  increase  the  size  after  a  while. 

There  are  a  great  many  devices  in  the  form  of  pessaries; 
some  of  them  are  absurdly  ridiculous,  and  more  in  the 
nature  of  instruments  of  torture  than  of  remedial  expedients. 
Since  I  learned  to  know  better,  I  no  longer  recommend 
them,  and  those  who  desire  a  radical  cure  for  a  prolapse  of 
any  kind,  will  surely  be  disappointed  if  they  pin  their  faith 
to  them. 

I  am  convinced  that  they  are  a  great  source  of  evil,  and 
a  sure  index  of  ignorance  on  the  part  of  those  who  habitu- 
ally recommend  them.     The  German  school  of  gynecolo- 


PROLAPSUS    OR    FALLING   OF   THE   WOMB.  239 

gists  have  of  late  years  greatly  perfected  the  plastic  operations 
of  the  vagina,  in  fact,  it  is  almost  a  sub-specialty  in  itself,  to 
which  they  have  given  the  term  prolapse  operations.  A 
specialist,  who  is  competent  in  the  details  of  these  prolapse 
operations,  can  hold  out  the  very  best  possible  chance  for  a 
radical  and  permanent  cure,  and  while  the  operation  re- 
quires a  certain  degree  of  skill  and  special  training,  which 
should  be  obtained  by  practicing  these  operations  on  the 
cadaver,  in  order  to  save  time,  and  not  bungle  the  operation 
on  the  living  subject,  as  too  often,  unfortunately,  happens. 
In  skillful  hands,  the  operation  is  entirely  without  danger, 
and  under  proper  antiseptic  precautions,  the  results  are  very 
satisfactory. 

The  question  is  simply  this:  If  the  knee-chest  treatment, 
and  the  remedies  that  have  been  suggested,  do  not  give  per- 
manent relief,  then  there  must  be  some  such  defect  in  the 
pelvic  floor  as  I  have  heretofore  described. 

If  the  vagina  is  too  wide,  it  should  and  can  be  narrowed 
to  its  normal  dimensions,  by  removing  the  excessive  tissue ; 
if  the  vagina  is  torn  into  the  perineum,  this  too  must  be 
united.  Should  the  cervix  of  the  uterus  be  abnormally 
elongated,  so  that  it  makes  it  physically  impossible  to  return 
it  to  its  natural  position,  it  should  be  shortened  or  ampu- 
tated, and  if  all  these  three  complications  coexist,  then  an 
operation  combining  and  remedying  all  these  defects,  should 
be  performed  at  one  sitting.  This  method  alone  will  restore 
the  patient  to  health  and  usefulness. 


CHAPTER   XX. 

VERSIONS  AND  FLEXIONS  OF  THE  UTERUS. 

Version,  in  the  nomenclature  of  diseases  of  the  womb' 
means  that  the  entire  organ  without  any  deflection  in  its 
normal  axis  turns,  inclines  or  leans  either  forwards,  back- 
wards or  sidewards. 

The  prefix  ante  is  used  in  the  sense  of  forwards  and  in 
composition  with  version  we  have  the  word  anteversion,  which 
in  conjunction  with  the  term  uterus,  signifies  that  the  organ 
is  inclined  forwards.  The  prefix  retro,  signifies  backwards, 
and  in  composition  with  the  word  version  and  in  connection 
with  the  word  uterus,  it  implies  that  the  womb  is  turned 
backwards. 

The  word  flexion  differs  from  version,  inasmuch  as  it  sig- 
nifies a  bending  or  bowing,  which  breaks  the  normal  axis 
of  the  womb.  The  neck  or  cervix  of  the  uterus  may  retain 
its  normal  position,  while  its  body  is  abnormally  deflected  or 
bent  in  any  direction.  The  prefixes  ante  and  retro  are  also 
used  in  composition  with  the  word  flexion  as  they  are  with 
version.     These  distinctions  should  be  remembered. 

ANTEVERSION   OF   THE   UTERUS. 

In  anteversion  the  uterus  has  so  far  changed  its  normal 
shape  that  the  cervix  of  the  organ  is  stretched  out  or  ex- 
tended in  a  line  with  the  axis  of  the  body.  This  occurs 
when  the  uterus  is  unusually  swollen  from  inflammatory 
enlargement.  The  normal  location  of  the  body  does  not 
materially  change  in  these  cases.  It  is  a  little  more  de- 
pressed on  the  fundus  of  the  bladder  and  the  cervix  is 
correspondingly  elevated,  so  that  the  latter  stands  consider- 
ably higher  than  in  health.     If  the  bladder  is  empty,  and 

(240) 


VERSIONS   AND    FLEXIONS   OF   THE   UTERUS.  241 

the  patient  bears  down  or  does  anything  that  increases  the 
intra-abdominal  pressure,  the  body  of  the  womb  is  forced 
down,  upon  the  anterior  vaginal  wall,  which  prolapses  into 
the  vagina,  while  the  cervix  is  raised,  so  as  to  point  upwards 
and  backwards.  When  the  bladder  is  full,  the  body  of  the 
uterus  is  naturally  raised,  and  the  cervix  correspondingly 
depressed.  And  this  is  attributable  to  a  rigidity  or  stiffness 
about  the  organ,  that  is  characteristic  of  a  chronic  inflam- 
matory enlargement  of  the  uterus.  Sometimes  the  organ  is 
permanently  fixed  by  inflammatory  adhesions,  that  lessen 
or  prohibit  these  movements. 

The  symptoms  of  anteversion  are  what  may  be  expected 
from  an  enlarged  congested  organ.  This  enlargement  is 
due  either  to  a  subinvolution  of  the  uterus  or  to  an  inflam- 
mation of  the  intermuscular  substance,  a  chronic  metritis. 
One  of  the  most  annoying  symptoms  of  the  anteverted 
uterus  is  the  feeling  of  looseness  in  the  pelvic  cavity.  This 
is  partly  due  to  the  relaxed  state  of  the  surrounding  tissue, 
and  partly  to  the  abnormal  size  of  the  womb.  The  patient 
feels  the  organ  roll  from  side  to  side,  as  she  changes  her  po- 
sition. This  causes  unnatural  sensations  and  mental  suffer- 
ing that  disturbs  the  nervous  system  and  induces  hysterical 
complications.  And  the  patient  complains  about  something 
moving  in  her  abdomen. 

The  inflammatory  adhesions  that  sometimes  tie  down 
the  organ  in  an  anteverted  position,  compromise  the  nor- 
mal expansion  of  the  bladder;  this  induces  an  irritation, 
which  causes  a  frequent  desire  to  urinate. 

The  treatment  must  be  directed  to  the  removal  of  the 
cause.  This  disease  is  really  only  a  symptom  or  condition 
of  chronic  corporeal  metritis  or  subinvolution,  and  as  such, 
it  is  only  amenable  to  the  measures  that  will  cure  this  dis- 
ease. The  employment  of  rings  and  pessaries  to  remedy 
this  evil  is  contrary  to  good  sense  and  of  no  permanent 
value. 

The  intelligent  employment  of  electricity,  so  as  to  stimu- 
16 


242  HOME    TREATMENT. 

late  the  absorption  of  the  hypertrophic  enlargement  of  the 
uterus  and  cause  the  absorption  of  the  inflammatory  adhe- 
sions, will  often  give  permanent  and  positive  results. 

ANTEFLEXION    OF    THE    UTERUS. 

This  was  considered  at  one  time  the  most  frequent  of  all 
uterine  displacements,  not  because  it  existed  formerly  oftener 
than  at  present,  but  because  the  natural  or  normal  position 
of  the  womb  was  confounded  with  that  which  was  supposed 
to  be  abnormal. 

The  discovery  that  in  the  living  subject  the  body  of 
the  uterus  naturally  inclines  forward,  so  as  to  rest  on  the 
bladder,  and  that  the  body  makes  quite  an  angle  with  its 
cervix,  altered  the  conception  of  things  very  materially* 
To-day  an  actual  aggravated  anteflexion,  that  occasions  no 
impediment  to  the  menstrual  discharge,  is  not  a  proper 
ground  for  treatment,  although  this  is  as  yet  by  no  means 
familiar  to  physicians  in  general,  for  many  of  them  have 
not  learned  to  make  the  distinction. 

The  reader  should  carefully  study  Plate  II,  which  dia- 
gramatically  illustrates  how  the  body  bows  over  the  bladder 
so  as  to  show  its  natural  anteflexion.  If  the  angle  between 
the  body  and  neck  of  the  womb  becomes  too  sharp  or  acute, 
so  that  the  canal  of  the  uterus  becomes  compressed  at  the 
point  of  flexion,  in  a  degree  that  obstructs  the  escape  of  the 
natural  secretions  of  the  uterine  cavity,  then  the  anteflexion 
becomes  a  source  of  disease.  This  degree  of  flexion  is  hap- 
pily very  rare,  and  we  find  it  in  about  equal  proportions  due 
to  a  congenital  defect,  that  springs  into  prominence  when  the 
girl  arrives  at  puberty,  for  then  the  obstruction  to  the  men- 
strual flow  is  first  realized. 

The  other  class  acquire  the  affection  in  adult  life,  after  a 
once  healthy  or  natural  menstruation  has  been  established. 
Of  this  class  there  are  two  species,  which  must  be  separately 
analyzed,  so  as  to  avoid  a  confusion  of  ideas,  that  often 
makes  this  subject,  which  is  the  most  simple,  one  of  the  most 
intricate,  in  the  text  books  in  gynecological  practice. 


VERSIONS    AND    FLEXIONS    OF    THE    UTERUS.  243 

One  variety  of  the  acquired  affection  can  be  described, 
in  common  with  the  congenital  form,  to  which  I  first  re- 
ferred: because  the  antefiexions  in  both  cases  are  due  to 
precisely  the  same  pathological  conditions,  namely,  a  loss 
of  muscular  tone  in  the  uterine  walls,  so  that  the  organ  be- 
comes flabby  and  weak,  like  a  green  wilted  stalk,  allowing 
the  body  of  the  uterus  to  topple  forwards. 

The  relaxation  of  the  uterine  walls  is  usually  more  pro- 
nounced at  that  portion  which  is  distinguished  as  the  isth- 
inus  of  the  uterus,  and  corresponds  to  that  part  of  the  organ 
where  the  cervix  goes  over  into  the  body,  forming  a  sort  of 
natural  hinge  joint  between  body  and  neck. 

If  the  bladder  is  empty,  the  body  of  the  womb  will 
naturally  drop,  not  necessarily  forwards,  for  it  may  fall 
backwards,  but  in  the  majority  of  cases  it  drops  forwards, 
because  the  womb  is  already  inclined  forwards  in  its  natural 
position,  so  all  that  is  necessary  to  induce  an  excessive 
anteflexion,  is  for  the  body  of  the  uterus  to  sink  lower  than 
it  is  natural  for  it  to  be.  A  kink  or  sharp  bend  will  cause 
in  any  canal  an  occlusion.  Take  a  small  rubber  tube,  for 
instance,  and  bend  it  sharply  at  right  angles;  the  result  will 
be  at  the  corner  of  the  deflection,  that  the  tube  will  be  flat- 
tened, and  its  walls  will  come  together.  In  the  case  of  the 
uterine  canal,  where  there  is  an  abnormal  flexion,  there  is 
precisely  the  same  condition,  and  as  a  result  an  obstruction 
not  only  to  the  menstrual  fluid,  but  to  the  mucous  secretions, 
which  are  pent  up  in  the  uterine  cavity.  The  retained  fluids 
decompose  and  irritate  the  mucous  lining;  and  this  entails 
a  complication  of  inflammatory  diseases,  which  can  never 
be  cured,  unless  the  flexion  is  remedied. 

The  other  variety  of  the  acquired  flexion  is  due  to  a 
pelvic  cellulitis.  This  is  an  inflammatory  process,  entirely 
outside  of  the  uterus. 

The  womb  is  surrounded  by  a  great  deal  of  loose  cellular 
tissue,  that  fills  out  the  interspaces  between  the  different 
ligaments  and  pelvic  organs.     This  tissue  often  becomes  the 


244  HOME    TREATMENT. 

seat  of  an  inflammation.  The  exudation  from  the  inflamma- 
tion may  be  of  such  a  nature  that  it  forms  strands  of  fibrous 
tissue,  running  from  the  isthmus  of  the  uterus  backwards  to 
the  sacrum.  These  strands  contract  or  shrink  in  the  course 
of  time,  and  this  draws  the  isthmus  of  the  uterus  backwards, 
and  fixes  or  attaches  it  to  the  posterior  pelvic  wall.  By  this 
contraction  of  the  fibrous  tissue  the  cervix  is  constricted  and 
the  body  falls  unnaturally  forwards. 

The  prominent  symptoms  of  anteflexion  are  painful  men- 
struation and  sterility.  Dysmenorrhea  or  painful  menstrua- 
tion is  the  first  sign  of  the  existence  of  anteflexion  at  the 
age  of  puberty.  It  happens  that  young  girls  are  thus  tor- 
tured for  days  with  violent  uterine  colic,  that  is  occasioned 
by  spasmodic  efforts  of  the  uterus  to  force  through  the  con- 
stricted canal  the  pent-up  secretion.  This  lasts  until  the 
menstrual  fluid  has  sufficiently  dilated  the  cervical  constric- 
tion to  allow  its  escape.  These  painful  paroxj-sms  of  uter- 
ine colic  repeat  themselves  at  each  recurring  menstrual 
period,  and  through  these  repetitions  of  pain  and  suffering, 
the  general  health  becomes  greatly  deranged.  The  nervous 
system  becomes  the  seat  of  functional  disturbances,  and  hys- 
terical disorders  are  not  uncommon. 

The  organ  becomes  involved  in  chronic  inflammatory 
processes  that  make  the  uterus  exceedingly  sensitive,  so 
that  the  colicky  pains  become  aggravated  and  prolonged 
far  beyond  the  cessation  of  the  menses.  Some  of  these  pa- 
tients suffer  for  several  weeks,  from  the  time  the  courses 
ought  to  begin,  so  that  they  are  actually  sick  half  the  time. 

Sterility  is  not  an  absolute  certainty  in  all  these  cases, 
but  it  is  traced  so  often  to  an  aggravated  flexion,  that  it  may 
be  accepted  as  one  of  its  most  prominent  signs.  Conception 
has  taken  place  in  extreme  flexions,  because  the  spermatozoa 
can  gain  admittance  into  the  uterine  cavity  for  several  days 
after  the  uterine  colic  and  menstrual  fluid  have  forced  the 
canal  open.  And  if  the  uterus  has  not  become  involved  in 
inflammatory  processes,  then  conception  is  the  means  by 
which  nature  effects  a  cure  through  her  own  resources. 


VERSIONS   AND    FLEXIONS   OF   THE   UTERUS.  245 

During  the  menstrual  period,  the  anteflected  uterus  be- 
comes greatly  congested  and  swollen,  and,  having  already 
grown  considerably  larger  from  the  chronic  inflammatory 
conditions  which  the  anteflexion  has  induced,  it  impinges  on 
the  bladder,  so  as  to  interfere  with  its  free  expansion.  This* 
occasions  a  frequent  desire  to  void  urine,  and  this  becomes  a 
very  distressing  symptom  in  a  certain  proportion  of  cases. 

Treatment  for  this  affection  is  not  within  the  sphere  of 
the  original  purpose  of  this  work,  for  the  efforts  at  home 
treatment  must  be  aided  by  mechanical  methods  of  the 
physician.  From  what  we  are  taught  of  "the  physical  cause 
of  this  affection,  the  fact  seems  self-evident  that  the  acute  or 
sharp  flexion  must  be  modified  to  give  permanent  relief. 
The  employment  of  rings,  pessaries,  sponges  or  medical  ap- 
plications are  nonsensical,  and  the  method  of  introducing  a 
stem  in  the  uterine  cavity,  for  the  patient  to  wear  for  an  in- 
definite length  of  time,  is  not  without  great  danger.  Even 
though  a  woman  cannot  give  herself  all  the  proper  treat- 
ment, it  must  be  a  great  satisfaction  to  her  to  be  informed  of 
the  proper  methods  that  should  be  adopted. 

The  vagina  should  be  thoroughly  rinsed  before  each 
and  every  treatment  of  the  uterus,  so  as  to  guard  against 
the  possibility  of  infecting  the  cavity  of  the  uterus. 

If  the  manipulations  that  are  required  for  the  purpose 
of  carrying  out  some  of  the  mechanical  or  surgical  treat- 
ments of  uterine  diseases,  were  always  preceded  with 
thorough  cleanliness,  which  implies  asepsis,  or  without 
putrescence,  then  all  these  operations  would  be  shorn  of 
their  greatest  danger,  namely,  that  of  exciting  inflammation 
and  suppuration. 

If  a  probe  of  the  usual  curve  can  be  readily  introduced 
into  the  supposed  anteflected  uterine  cavity,  then  there  can- 
not be  sufficient  flexion  to  constitute  an  obstruction,  hence 
the  flexion  is  not  the  cause  of  the  disease.  In  genuine  an- 
teflexion, the  cervix  and  body  of  the  uterus  are  doubled 
up  on  each  other,  often  like  the  letter  V,  the  cervix  repre- 


246  HOME    TREATMENT. 

sen  ting  one  line  of  the  V,  and  the  body  the  other;  bi- 
manimal  palpation  in  the  hands  of  an  expert  clearly  estab- 
lishes this  conformation. 

When  the  diagnosis  is  established,  the  treatment  should 
be  as  follows :  The  patient  is  inclined  on  a  table,  either  on 
her  back  or  side,  a  Sims'  speculum  is  introduced  into  the 
vagina  and  the  cervix  exposed.  The  posterior  lip  of  the 
cervix  is  now  seized  by  means  of  a  tenaculum  forceps,  and 
gently  drawn  downwards  and  backwards)  which  greatly  re- 
duces or  obliterates  the  angle  or  flexion  between  the  cervix 
and  the  body  of  the  womb,  this  greatly  facilitates  the  in- 
troduction of  a  uterine  electrode.  After  two  or  three  treat- 
ments, the  forceps  are  no  longer  required,  because  the  elec- 
trode can  then  be  readily  introduced  into  the  uterine  cavity 
without  them.  The  other  electrode  is  spread  on  the  ab- 
domen. (See  this  illustrated  on  Plate  V.)  A  current  of 
electricity  is  now  passed  through  the  uterine  tissues  for  ten 
minutes;  this  is  gauged  all  the  way  from  sixty  to  one  hun- 
dred milliamperes.  The  operation  is  repeated  only  once  a 
week,  and  the  cure  is  effected  in  six  weeks  to  three  months. 
Great  care  must  be  exercised  during  the  treatment,  to  avoid 
exposure  and  undue  exercise. 

Those  forms  that  are  due  to  inflammatory  deposits  and 
strands  outside  of  the  organ,  should  be  preceded  with  an 
electrical  treatment  twice  a  week,  somewhat  modified  from 
the  preceding  course.  This  is  done  by  employing  a  vaginal 
electrode,  properly  protected  and  gently  pressed  against  the 
adhesions.  The  other  electrode  is  applied  to  the  small  of  the 
back.  A  current  some  fifty  milliamperes  stronger  is  passed 
directly  through  the  adhesions;  when  these  are  absorbed, 
the  intra-uterine  electrode  is  employed,  as  in  cases  that  are 
not  complicated  with  them. 

RETROVERSION    OF    THE    UTERUS. 

This  consists  in  a  posterior  inclination  of  the  uterus,  so 
that  the  body  of  the  womb  approaches  the  posterior  walls  of 
the  pelvis,  while  the  cervix  of  the  womb  is  raised  against  the 
base  of  the  bladder. 


PLATE  IV. 


Retroflexion   of  the   Uterus,    or   the  Womb,  bent  backward. 

This  plate  elucidates  the  womb  bent  or  turned  backward  and  pressing  on  the 
rectum.  This  condition  is  generally  traceable  to  the  vicious  custom  of  lying-  on  the 
back  after  confinement  or  during  childbed.  The  natural  position  of  the  organ,  in- 
clined forward  and  resting  on  the  bladder,  is  also  shown. 


VERSIONS   AND   FLEXIONS   OF   THE   UTERUS.  247 

As  a  permanent  pathological  lesion,  this  form  of  displace- 
ment is  very  rare,  but  as  a  forerunner  of  retroflexion  it  is  of 
frequent  occurrence.  The  length  of  time  that  elapses  for  a 
version  to  take  on  a  flexion  depends  on  the  degree  of  indu- 
ration or  stiffness  of  the  uterine  walls. 

The  chronic  inflammatory  enlargement  of  the  uterus 
predisposes  the  organ  to  posterior  displacement,  and  the  dis- 
placement favors  the  development  of  flexion.  This  takes 
place  in  the  following  order :  After  the  uterus  is  displaced 
backwards,  and  its  cervix  has  become  fixed  by  inflamma- 
tory adhesions,  the  body  of  the  womb  gradually  glides  down 
on  the  posterior  pelvic  wall,  from  gravitation  and  intra- 
abdominal pressure.  And  in  this  very  simple  manner  a 
retroversion  is  converted  into  a  retroflexion.  The  causes, 
symptons,  and  complications  that  characterize  this  variety 
of  displacement,  with  its  subsequent  modification  into  flex- 
ion, are  the  same  as  those  of  retroflexion,  to  which  the 
reader  is  referred. 

RETROFLEXION    OF    THE    UTERUS. 

This  form  of  uterine  displacement  exists  when  the  body 
of  the  womb  is  bent  towards  the  posterior  wall  of  the  pelvis, 
which  is  in  an  opposite  direction  to  that  where  it  naturally 
belongs.  I  have  already  pointed  out,  in  speaking  of  the 
normal  position  of  the  uterus,  that  the  body  is  directed  for- 
wards and  rests  on  the  bladder,  while  its  cervix  points 
downwards  into  the  pelvic  cavity.  I  now  refer  you  to  Plate 
IV,  in  which  I  plainly  show  the  uterus  in  a  directly  oppo- 
site position  to  that  in  health,  namely,  turned  back,  resting 
on  and  depressing  the  rectum. 

In  retroflexion  the  cervix  of  the  uterus  continues  to  point 
downwards,  into  the  pelvic  cavity,  in  almost  the  same  di- 
rection as  in  the  natural  position,  while  the  body  is  directed 
backwards,  or  backwards  and  downwards.  We  seldom,  if 
ever,  find  this  condition  as  a  congenital  affection,  but  as  an 
acquired  displacement   it  is  undoubtedly  more   frequently 


^48  HOME   TREATMENT. 

met  with  in  gynecological  practice  than  all  other  displace- 
ments combined.  The  round  ligaments  of  the  uterus  were 
at  one  time,  and  are  even  yet  by  some,  supposed  to  be  the 
means  that  retain  the  womb  in  its  normal  anteflected  posi- 
tion. Upon  this  theory  a  new  surgical  oj)eration  sprung 
into  prominence  for  the  relief  of  this  class  of  cases.  It  was 
reasoned,  that  if  the  round  ligaments  actually  tied  the  uterus 
down,  and  retained  it  in  its  natural  anteflected  position,  that 
to  shorten  these  ligaments  by  opening  the  inguinal  canal  in 
the  groin,  and  drawing  them  out,  would  remedy  a  displace- 
ment of  the  womb,  whether  a  prolapsus  or  a  retroflexion. 
This  operation  was  performed,  it  was  claimed  successfully, 
and  if  the  view  that  the  round  ligaments  retain  and  support 
the  uterus  were  a  correct  one,  it  must  be  admitted  that  the 
operation  would  have  been  ideal.  I  convinced  myself,  how- 
ever, of  the  utter  fallacy  of  this  position,  in  dissections  on  the 
cadaver,  where  in  several  instances  the  round  ligaments 
could  not  be  reached  without  opening  the  abdominal  cavity, 
and  even  then  it  was  impossible  to  trace  them.  These 
views  were  expressed  in  an  article  in  the  American  Journal 
of  Obstetrics  and  Diseases  of  Women  and  Children,  and  as  the 
operation  fell  shortly  afterwards  into  merited  disrepute,  I 
partly  claim  the  credit  of  having  been  instrumental  in 
bringing  that  about.     I  said : 

"  That  this  ligament  has  nothing  to  do  in  fixing  the 
uterus  in  its  normal  ante  verted  position,  is  proven  from 
many  facts  which  occur  in  daily  practice.  The  insertion  or 
origin,  whichever  one  chooses  to  call  it,  of  these  cords  at  the 
groin,  is  somewhat  irregular  and  sometimes  so  rudimentary 
that  it  cannot  be  found  upon  a  most  careful  and  tedious 
dissection.  It  may  be  found  divided  into  a  number  of  proc- 
esses, one  being  connected  with  Poupart's  ligament  in  the 
inguinal  canal,  the  other  being  lost  in  the  labia  majora,  and 
another  may  be  traced  to  the  sheath  of  the  rectus  muscle. 

"  If  these  cords  were  so  important  as  the  advocates  of  the 
Alexander-Adams  operation  try  to  make  us  believe,  in  bind- 
ing the  uterus  forward,  and,  as  we  are  recently  informed, 
have  a  strength  equal  to  support  four  and  one-half  pounds 


VERSIONS    AND    FLEXIONS    OF   THE    UTERUS.  249 

weight,  a  great  deal  of  uneasiness,  if  not  actual  pain,  would 
be  felt  and  located  along  the  inguinal  canal,  following  this 
structure  to  its  points  of  insertion,  in  sudden  dislocations  of 
the  uterus  backwards.  This  is,  however,  not  the  case;  when 
sudden  painful  symptoms  arise,  they  are  invariably  referred 
to  the  sacral  region.  In  sudden  retroversions  or  flexions, 
as  in  the  pregnant  uterus,  occurring  accidentally  or  those 
retro  verted  or  flexed  uteri  which  are  so  often  met  with  in  a 
state  of  subinvolution  after  confinements,  there  are  no  symp- 
toms pointing  to  a  tension  of  these  cords  at  all,  biit  all 
symptoms  point  to  uterine  pressure  on  the  posterior  pelvic 
wall,  which  can  be  precisely  located.  And  these  pains  dis- 
appear as  soon  as  the  offending  member  is  put  right." 

There  is  no  doubt  that  the  uterus  retains  its  abnormal 
retroflected  position  by  the  same  forces  that  keep  it  in  a 
normal  or  anteflected  state;  these  are  (1)  intra-abdominal 
pressure,  and  (2)  the  force  of  gravitation  of  its  own  weight. 

In  some  women  there  are  certain  predispositions  to  the 
occurrence  of  a  retroflexion.  If  the  walls  of  the  uterus  are 
weak  and  relaxed,  especially  that  portion  where  the  cervix 
unites  with  the  body  of  the  womb,  then  the  body  may  fall 
in  any  direction,  and,  as  the  bladder  is  liable  to  be  dis- 
tended, and  thus  raise  the  body  of  the  uterus  upwards,  folds 
of  intestine  are  likely  to  intervene,  so  that  the  organ  is  in- 
clined backwards,  and  the  abdominal  pressure,  now  falling 
on  the  anterior  surface  of  the  body,  presses  the  womb  back- 
wards and  downwards  into  a  flexion. 

A  fall  backwards  or  a  violent  push  or  jump  may  cause 
retroflexion  any  time  during  life.  Retroflexions  of  this  na- 
ture are  not  as  a  rule  injurious,  and  if  the  circulation  is  not 
compromised,  nor  the  uterine  canal  obstructed,  women  may 
go  through  life  without  feeling  any  the  worse  because  their 
womb  occupies  an  abnormal  position.  It  is  only  when  the 
organ  is  congested  and  swollen,  so  that  its  own  tissue  is  pain- 
fully sensitive,  and  the  surrounding  tissues  are  compressed 
by  the  foreign  body,  that  it  requires  measures  for  relief. 

In  those  women  who  have  borne  children,  and  those 
who  have  gone  through  a  miscarriage,  retroflexion  is  fre- 


250  HOME    TREATMENT. 

quently  met.  A  little  reflection  will  make  this  clear,  for 
when  we  remember  how  the  pregnant  uterus  at  any  time 
from  conception  to  final  delivery  becomes  congested  and 
the  seat  of  a  corresponding  growth  of  its  own  tissue  to  ac- 
commodate the  growing  fetus,  we  at  once  perceive  that 
either  after  an  abortion  or  on  delivery  at  full  term,  the  en- 
larged and  congested  uterus  is  in  the  best  possible  condition, 
to  lose  its  normal  place  and  sink  backwards.  The  per- 
nicious custom  in  vogue  in  most  countries,  of  keeping  a 
woman  on  the  flat  of  her  back  after  delivery,  has  never  been 
as  vehemently  opposed  by  the  intelligent  members  of  the 
profession,  as  the  gravity  of  the  subject  demands.  Some 
women  have  an  idea  that  the  longer  and  quieter  they  re- 
main on  their  backs,  the  surer  they  are  to  make  an  excellent 
recovery  from  the  lying-in  chamber.  American  and  En- 
glish practitioners  are  inclined  to  recommend  this  as  the 
most  proper  way  to  lie,  but  there  is  no  doubt  that  this  not 
only  favors  the  occurrence  of  retroflexion,  but  that  it  actu- 
ally causes  it. 

The  woman  who  rests  on  her  back  gives  to  the  heavy 
body  of  the  womb  an  opportunity  to  sink  backwards,  after 
the  distended  bladder  has  pushed  the  organ  high  enough  up 
so  that  its  own  weight  may  throw  it  over,  until  it  finds  resist- 
ance on  the  posterior  wall  of  the  pelvic  cavity.  Many  nurses 
insist  on  the  dorsal  position  for  days,  and  never  permit  the 
patient  the  privilege  of  lying  upon  one  or  the  other  side. 
Aside  from  the  injurious  effect  that  this  has  on  the  position 
of  the  uterus,  it  is  exceedingly  tiresome  to  be  compelled  to 
remain  for  several  days  in  one  position.  Women  should  be 
allowed  to  lie  on  all  sides,  after  delivery,  and  no  longer  on 
one  side  than  on  another.  And  to  insure  against  a  retro- 
version or  flexion,  she  must  also  lie  on  the  abdomen  a  cer- 
tain length  of  time  during  each  twenty-four  hours. 

Tight  bandaging  after  delivery,  for  "  preserving  the  fig- 
ure," greatly  aggravates  the  displacement ;  the  binder  should 
be  so  applied  that  it  feels  comfortable  but  not  too  tight,  its 


VERSIONS   AND    FLEXIONS   OF   THE   UTERUS.  251 

purpose  being  to  offer  a  gentle  support  to  the  suddenly  re- 
laxed abdominal  muscles,  and  thus  stimulate  them  to  con- 
tract to  their  normal  form. 

The  symptoms  of  retroflexion  are  greatly  varied  by  the 
pathological  conditions  that  affect  the  uterus,  or  by  the  com- 
plications that  may  have  caused  the  flexion. 

It  is  indisputable  that  the  uterus  may  be  retroflected  for 
an  indefinite  length  of  time  without  causing  any  inconven- 
ience. From  this  it  may  be  inferred  that  the  retroflection 
itself  does  not  constitute  the  disease,  but  the  inflammatory 
processes,  in  which  the  organ  is  involved,  or  the  relaxation 
of  the  adjacent  structures,  as  we  find  them  immediately  after 
confinement,  constitute  the  actual  diseased  conditions. 

One  of  the  most  constant  symptoms  is  pain  in  the  back, 
and  this  is  severe  in  proportion  to  the  swelling  and  sensi- 
tiveness of  the  organ,  when  it  presses  on  the  sacral  nerves 
and  rectum. 

As  a  result  of  the  flexion,  the  circulation  in  the  organ  is 
interfered  with,  so  that  the  congested  uterus  feels  heavy, 
and  there  is  a  sensation  of  fullness  and  bearing  down,  that 
greatly  hinders  walking.  Uterine  catarrh  and  hyperemia 
place  the  organ  in  such  an  irritable  state  that  prolonged 
and  excessive  menstruation  is  the  rule.  This  may  last  for 
fourteen  days,  so  that  the  patients  become  ansemic  and 
greatly  debilitated  from  the  excessive  loss  of  blood.  The 
menstruation  is  always  more  painful,  especially  at  the  be- 
ginning of  the  flow;  this  pain  maybe  interrupted,  or  spas- 
modic, so  that  it  assumes  the  form  of  a  uterine  colic;  the 
lower  abdominal  region  becomes  painful  and  the  pain  radi- 
ates towards  the  groins.  The  degree  of  suffering  is  very 
seldom  as  great  as  that  which  characterizes  anteflexion,  be- 
cause the  obstruction  in  the  latter  flexions  are  much  greater 
than  in  retroflexions. 

Those  women  who  have  borne  children  suffer  less  pain 
during  menstruation  than  those  who  have  never  been  preg- 
nant.   It  may  be  presumed  that,  in  the  latter  class,  the  flex- 


252  HOME    TREATMENT. 

ion  was  congenital  or  acquired  in  early  childhood,  which 
makes  the  obstruction  or  constriction  more  complete  and 
obstinate,  and  for  that  reason  it  induces  sterility.  With 
those  who  have  once  borne  and  afterwards  acquired  the  flex- 
ion, the  possibility  of  conception  is  much  greater. 

When  the  enlarged  and  swollen  body  of  the  uterus  is 
pushed  backwards  and  downwards,  it  presses  on  the  sacral 
plexus  of  nerves;  this  is  a  bundle  of  nerves  that  supplies 
branches  to  the  legs,  and  from  this  pressure  the  lower  ex- 
tremities become  lame  or  paralyzed  either  on  one  or  both 
sides.  The  paralysis  subsides  after  the  removal  of  the  of- 
fending body.  There  is  quite  a  number  of  other  neurotic 
affections  that  can  often  be  traced  to  a  retroflected  uterus. 
These  are  all  of  a  functional  nature,  and  appear  in  the  form 
of  hysteria,  epilepsy,  St.  Vitus'  dance  and  neuralgias  of  almost 
any  part  of  the  body.  Dr.  Chrobak,  of  Vienna,  reported 
a  case  of  asthma  that  had  resisted  all  the  treatments  that 
could  be  suggested,  until  it  was  finally  traced  to  a  retro- 
fleeted  uterus;  that  being  rectified,  the  asthma  subsided. 

Irritability  of  the  bladder  is  not  so  frequent  a  symptom 
of  this  variety  of  displacement  as  of  others ;  should  there  be 
inflammation  complicating  the  bladder,  then,  of  course, 
there  would  be  considerable  annoyance  from  this  source. 

Habitual  constipation  is  often  very  prominent  and  in 
some  of  the  cases  it  is  the  only  sign  that  leads  to  an  exam- 
ination, which  reveals  the  retroflexion.  Hemorrhoids  or 
piles,  due  to  a  compression  of  the  veins  of  the  rectum,  are 
another  complication  included  in  the  signs  of  this  displace- 
ment. 

TREATMENT. 

There  is  a  small  proportion  of  cases  in  which  the  system 
has  become  accustomed  to  the  retroflected  position  of  the 
womb,  and  if  the  abnormal  condition  is  rectified,  a  great 
many  painful  symptoms  spring  into  prominence,  that  are 
attributable  to  the  interference.  This  is  particularly  the 
case  in  women  who  are  in  those  years  that  we  term  "  change 
of  life,"  and  for  this  reason  they  should  be  let  severely  alone. 


VERSIONS    AND    FLEXIONS    OF    THE    UTERUS.  253 

Excluding  the  above  class  of  cases,  the  question  arises  in 
other  cases  whether  the  uterus  can  be  replaced  without 
violence,  or  whether  it  is  fixed  or  grown  to  its  surroundings 
by  inflammatory  adhesions.  It  is  not  always  an  easy 
matter  to  dispose  of  this  question  at  once,  because  the  en- 
larged and  congested  body  is  often  so  firmly  wedged  down 
between  the  posterior  pelvic  wall  and  the  vagina,  that  any 
attempt  to  dislodge  it  is  accompanied  with  such  acute  pain 
that  one  feels  constrained  to  desist  for  a  time.  When  there 
is  great  pain  or  sensitiveness,  the  patient  should  take  to  bed, 
so  as  to  give  the  pelvic  organs  every  chance  to  get  rid  of  the 
inflammatory  irritability.  Hot-water  compresses  should  be 
applied  to  the  lower  abdominal  or  pelvic  region,  and  hot 
vaginal  irrigations  thrown  into  the  vagina;  these  should  be 
copious,  no  less  than  a  gallon  of  water  at  once,  at  a  temper- 
ature of  107  to  110°  Fahr.,  repeated  twice  daily.  The  bow- 
els should  be  kept  loose,  say  several  operations  each  day, 
for  three  or  four  days;  after  that  once  a  day  will  be  suffi- 
cient. 

In  the  course  of  several  weeks  the  congestion  will  have 
subsided,  so  that,  in  the  great  majority  of  cases,  reposition 
can  be  readily  accomplished.  If  the  resistance  of  the  womb 
still  persists,  then  it  is  reasonable  to  infer  that  the  organ  is 
tied  down  by  old  inflammatory  adhesions;  these,  then, 
should  be  treated  with  galvanism,  after  the  manner  described 
for  removing  adhesions  in  antenexions. 

The  statistics  show  that,  out  of  every  five  women  who 
are  suffering  from  female  diseases,  one  has  a  posterior  dis- 
placement, either  a  retroflexion  or  retroversion.  The  great- 
est number  of  these  are  traceable  to  their  last  confinement. 
All  these  displacements,  as  well  as  those  that  are  accidental 
or  induced  by  a  fall,  jumps  or  the  like,  should  be  replaced 
as  soon  as  possible,  otherwise  inflammatory  adhesions  may 
complicate  and  greatly  obstruct  the  replacement. 

The  reposition  or  replacement  of  the  womb  may  be  ac- 
complished through  natural  agencies,  that  can  be  employed 


254  HOME    TREATMENT. 

by  the  patient  herself.  These  are,  in  a  great  measure,  the 
same  forces  to  which  the  womb's  posterior  displacements  are 
to  be  attributed,  namely,  intra-abdominal  pressure  and  grav- 
itation. To  employ  these  for  the  purpose  of  remedying  the 
evil,  the  so-called  knee-chest  position  must  be  assumed  by 
the  patient.  The  first  step  towards  assuming  this  position 
is  to  get  down  on  the  bended  knee,  the  thighs  in  a  vertical 
position,  then  the  body  is  gradually  inclined  forwards  until 
one  or  the  other  shoulder  touches  the  floor  or  level  of  the 
knee.  If  this  position  is  retained  for  ten  minutes  it  will 
alone  replace  the  organ  forwards,  sometimes  suddenly,  at 
other  times  gradually,  provided  the  organ  is  moveable  and 
not  squeezed  into  the  pelvis  or  adhered  by  inflammatory  ex- 
udation. 

Dr.  Henry  F.  Campbell,  of  Georgia,  introduced  this  nat- 
ural therapeutic  agent  into  the  profession,  but  it  appears  to 
be  very  little  known  or  understood  by  the  profession,  per- 
haps because  it  is  so  very  simple.  Dr.  Munde,  in  an  article 
on  "  Uterine  Displacement  and  Its  Curability,"  in  the  Amer- 
ican Journal  of  Obstetrics,  indorses  the  knee-chest  or  knee- 
shoulder  position  in  the  following  language :  "A  moment's 
thought  will  demonstrate  the  utility  of  this  combined  vis  a 
f route  (gravitation  of  the  abdominal  viscera  towards  the  dia- 
phragm) and  vis  a  tergo  (air  suction  into  the  vagina  and  pres- 
sure against  the  vaginal  roof).  This  position  is  to  be  as- 
sumed several  times  daily,  and  maintained  each  time  as  long 
as  the  patient  can  bear  it,  continued  for  months,  if  neces- 
sary; the  best  time  is  at  night  at  retiring,  when  the  lateral 
position  is  to  be  taken  for  the  night-" 

In  a  certain  proportion  of-  cases  the  knee-chest  position 
alone  will  not  dislodge  the  retroflected  uterus,  so  that  man- 
ual aid  is  required  to  effect  that  purpose.  There  is  a  num- 
ber of  methods  that  have  been  suggested  from  time  to  time, 
but  none  are  so  good  as  that  in  which  the  knee-chest  position 
is  combined  with  the  manipulation  of  the  operator.  Reposi- 
tion may  occur  spontaneously,  and  it  undoubtedly  does  in  a 


VERSIONS   AND    FLEXIONS   OF   THE   UTERUS.  255 

large  proportion  of  cases,  in  whicli  the  retroflected  organ  be- 
comes pregnant.  When  the  retroflected  organ  occasions 
symptoms  of  retention  of  urine,  the  bladder  should  first  be 
emptied  with  a  soft  No.  8  catheter,  then  the  patient  is  di- 
rected to  kneel  on  both  of  her  knees,  her  thighs  remaining 
perpendicular,  while  her  body  inclines  forward  until  one  or 
the  other  shoulder  touches  the  floor  or  level  of  her  knees. 
The  operator  may  then  gradually  lift  the  womb  and  elevate 
the  body  sufficiently  so  that  it  will  fall  forward  into  its  nat- 
ural place.  When  there  is  no  bladder  trouble  from  compres- 
sion, and  the  womb  resists  even  mild  force  to  replace  it,  I 
have  accomplished  gradual  reposition  by  keeping  the  woman 
in  bed  for  three  or  four  weeks,  with  the  instructions  that  she 
resume  the  knee-shoulder  position  two  or  three  times  a  day, 
and  from  five  to  ten  minutes,  also  that  she  shall  lie  on  her 
side  and  chest  and  never  on  her  back.  In  this  manner  I 
have  accomplished  in  time  and  without  force  what  could 
not  have  been  accomplished  with  forcible  attempts  without 
inducing  an  abortion. 

It  curiously  happens  that  there  are  cases  of  retroflection 
which  are  never  suspected  nor  recognized  until  the  patient 
has  become  pregnant.  After  the  woman  is  about  three 
months  gone,  the  growth  of  the  pregnant  uterus  can  no 
longer  be  accommodated  in  the  pelvis,  because  the  direction 
of  its  growth  is  in  the  direction  of  the  retroflected  organ, 
namely,  backwards  and  downwards  (see  Plate  IV)  which 
makes  it  a  physical  impossibility  to  escape  from  or  grow  out 
of  the  bony  pelvis.  The  symptoms  are  retention  of  urine 
or  a  constant  dribbling  of  urine^and  a  straining  at  stool  or 
pain  in  the  rectum  or  pelvis,  and,  of  course,  the  absence  of 
the  menses  since  the  commencement  of  pregnancy.  Retro- 
flection  may  be  also  acquired  during  the  first  three  or  four 
months  of  normal  pregnancy,  from  a  jump  or  fall  on  the 
back,  in  which  all  the  symptoms  that  indicate  this  condition 
are  suddenly  manifested. 

In  pregnancy,  the  course  that  is  to  be  pursued,  in  order 


256  HOME    TREATMENT. 

to  rectify  the  displacement,  must  be  obviously  different 
from  that  pursued  when  the  woman  is  not  pregnant.  The 
pregnant  uterus  is  a  "touch  me  not;"  it  permits  of  no  tam- 
pering without  running  the  fearful  risk  of  inducing  an  ab- 
ortion, and  no  one  but  a  tyro  or  an  ignoramus  will  ever 
meddle  with  the  pregnant  womb. 

The  replacement  of  the  retroflected  uterus,  that  is  posi- 
tively not  pregnant,  and  there  must  be  no  question  about  it 
either,  will  admit  of  introducing  a  sound  into  its  cavity. 
This  sound  is  used  as  a  lever  upon  which  the  organ  may  be 
lifted  out  of  its  abnormal  position  and  inclined  over  the 
bladder  in  an  anteflected  position,  which  is  its  natural  one. 
The  sound  which  I  employ,  and  which  is  my  own  invention, 
for  replacing  the  uterus  is  screwed  into  a  thimble,  and  from 
two  and  one-half  to  three  inches  long.  The  object  of  this 
is  to  artificially  elongate  the  finger  so  that  it  can  be  intro- 
duced into  the  womb.  The  force  which  one  employs  by 
using  this  instrument  is  keenly  appreciated  by  the  operator, 
hence  there  can  be  no  undue  strain,  that  otherwise  might 
be  exerted  on  adhesions  which  are  too  strong  to  be  safely 
lacerated  or  even  stretched,  while  slight  and  recent  adhe- 
sions might  be  torn  without  any  bad  results.  Truax,  of  Chi- 
cago, manufactures  my  repositor. 

Before  introducing  any  sound  into  the  uterine  cavity,  it 
is  absolutely  necessary  that  the  vagina  should  be  thoroughly 
cleansed  with  borax  water. 

The  inflammatory  enlargements  of  the  womb,  subinvo- 
lutions, uterine  catarrhs,  and  any  of  the  complications  that 
may  exist  at  the  time  that  the  organ  is  replaced,  should  be 
treated  on  the  same  principles  that  have  been  laid  down  in 
the  respective  chapters  on  these  diseases;  in  fact,  these  com- 
plications constitute  part  of  the  after  treatment  for  retrover- 
sion or  flexion.  The  other  treatment  is  to  be  directed  toward 
retaining  the  womb  where  it  naturally  belongs.  The  daily 
exercise  in  the  knee-chest  position  should  never  be  neglected, 
and  in  cases  in  which  this  is  insufficient,  it  is  very  probable 


VERSIONS   AND    FLEXIONS   OF   THE   UTERUS.  257 

that  the  pelvic  floor  or  natural  support  of  the  uterus  has 
been  injured  or  lacerated  during  confinement,  and  this  may 
require  a  plastic  operation  as  a  preliminary  to  a  cure.  In 
obstinate  cases  there  is  no  cure  so  effectual  as  pregnancy 
and  a  full-time  delivery,  provided  precautions  are  taken  so 
that  the  mother  will  not  acquire  a  new  retroflexion  during 
her  lying-in  period,  from  the  cause  that  has  been  already  de- 
tailed. The  patient  must  accustom  herself  to  sleep  either  on 
the  chest  with  face  turned  to  one  or  the  other  side,  or  in  a 
semi-prone  position  on  either  the  right  or  left  side.  Persever- 
ance in  sleeping  in  this  manner  for  a  few  weeks  cultivates 
the  habit  that  gives  more  refreshing  sleep  than  lying  on  the 
back,  which  most  persons  are  inclined  to  do. 


17 


CHAPTER  XXI. 

DISEASES  OF  THE  FALXOPIAN  TUBES. 

The  Fallopian  tubes  are  the  ovi  ducts,  along  which  the 
sperm atozoids  pass  from  the  womb  to  fertilize  the  ovum, 
and  along  which  the  fertilized  or  non-fertilized  ovum,  as 
the  case  may  be,  is  carried  to  the  cavity  of  the  uterus. 

They  are  two  small  canals,  between  three  and  a  half  and 
four  inches  in  length,  and  constitute  the  only  means  of  com- 
munication between  the  womb  and  ovaries ;  their  caliber  is 
exceedingly  small  and  lined  with  a  delicate  mucous  mem- 
brane. 

The  diseases  which  affect  the  Fallopian  tubes  are  inflam- 
mation, stricture,  distention  and  displacements. 

The  inflammation  is  distinguished  as  salpingitis,  from 
salpinx,  Fallopian  tube,  and  itis,  in  composition,  inflammation ; 
this  consists  of  a  catarrhal  inflammation  of  the  lining  mem- 
brane of  the  tubes,  which  rarely  if  ever  originates  in  the 
tubes  themselves,  but  is  secondary  to  an  inflammatory  proc- 
ess in  the  neighboring  organs. 

Chronic  endometritis  or  catarrh  of  the  womb  is  undoubt- 
edly the  most  fruitful  cause  of  salpingitis,  although  this  is 
not  absolutely  the  rule,  for  there  are  some  women  who  have 
had  uterine  catarrh  for  years  without  its  affecting  the  tubes 
in  the  least.  But  there  is  a  type  of  uterine  catarrh  that  has 
a  special  tendency  to  spread  from  the  womb  to  the  lining 
membrane  of  the  tubes,  and  this  is  the  infectious  endome- 
tritis. An  infectious  inflammation  of  the  womb  may  be 
due  to  many  different  sources  of  infection ;  the  retained 
products  of  conception  after  an  abortion  may  become  pu- 
trescent and  furnish  one  source ;  carrying  putrefactive  germs 
into  the  uterine  cavity  from  the  vaginal  canal  by  means  of 

(258) 


DISEASES   OF   THE   FALLOPIAN   TUBES.  259 

probes  or  instruments,  that  are  in  themselves  denied  by  not 
having  been  thoroughly  cleansed  and  purified  since  their 
last  employment,  is  another  source  of  infection ;  the  lat- 
ter is  perhaps  the  commoner  cause  of  blood  poisoning  in 
criminal  abortions  by  the  abortionists.  Gonorrheal  infec- 
tion seems  to  have  a  greater  tendency  than  any  other  to 
spread  itself  from  the  uterus  to  the  tubes ;  this  has  been  the 
subject  of  special  inquiry,  and  has  been  thoroughly  con- 
firmed, and  this  may  arise  many  months  after  the  infected 
male  has  imagined  himself  entirely  cured. 

The  diseases  of  the  tubes  that  I  have  enumerated  are  in 
the  relation  of  cause  and  effect ;  a  catarrhal  inflammation 
is  quite  likely  to  induce  a  stricture  or  an  occlusion,  and 
this  causes  a  distention  from  retention  of  the  secretions, 
whether  the  secretions  are  a  natural  or  an  inflammatory 
product.  If  the  inflammation  has  an  infectious  origin,  then 
the  retained  secretion  becomes  purulent,  or  it  may  be  a 
muco-pus  secretion  from  the  commencement.  The  dilated 
tube  may  also  contain  blood  or  serum  ;  the  latter  constitutes 
tubal  dropsy;  or  it  may  contain  a  fertilized  ovum;  this  gives 
rise  to  tubal  pregnancy. 

Tubal  dropsy  may  be  a  distention  of  the  tubes  when 
both  ends  are  sealed  by  inflammatory  adhesions ;  these  dis- 
tentions vary  in  size  from  the  thickness  of  a  finger  to  a 
large  ovarian  tumor,  from  which  it  is  not  an  easy  matter  to 
distinguish  it. 

The  most  dangerous  form  of  tubal  obstruction  and  dis- 
tention is  where  the  contents  are  pus  or  purulent  matter ;  this 
is  liable  to  be  poured  into  the  peritoneal  cavity  from  ulcer- 
ation or  rupture  of  the  sac,  and  excites  fatal  peritonitis. 

Salpingitis  can  only  be  viewed  as  a  complication  of  some 
prior  inflammatory  process  in  some  of  the  adjacent  organs 
and  tissues;  these  are  the  uterus  and  ovaries  and  the  pelvic 
peritoneum  and  pelvic  cellular  tissue. 

The  symptoms  of  inflammation  of  the  tubes  are  not  so 
•clearly  defined  as  to  indicate  the  nature  of  the  affection. 


260  HOME    TREATMENT. 

because  it  is  hardly  ever  limited  to  the  tubes  alone,  the  sur- 
rounding tissue  being  always  more  or  less  involved.  These 
patients  are  so  seldom  free  from  pain  that  their  lives  are  a 
constant  suffering.  If  the  pain  subsides,  it  is  only  for  a  few- 
days,  and  the  slightest  exertion  brings  about  a  relapse,  so 
that  walking  or  standing  must  be  avoided.  During  men- 
struation the  pain  always  increases,  and  the  menses  may  be 
excessive  at  one  period  and  scant  at  another  ;  these  harass- 
ing pains  make  powerful  inroads  on  the  patient's  strength  ; 
she  becomes  pale  and  debilitated,  while  her  emaciated  form 
and  careworn  expression  give  us  a  picture  of  the  typical  in- 
valid. Fortunately,  this  complication  is  not  as  frequent  as 
one  might  expect  from  the  intimate  relation  of  the  tubes  to 
the  womb  and  ovaries,  but  the  possibility  of  the  Fallopian 
tubes  becoming  inflamed  should  admonish  women  against 
taking  any  chances  by  neglecting  the  rules  of  hygiene,  that 
I  have  laid  down  in  another  chapter,  for  the  old  saying  that 
"prevention  is  better  than  cure"  is  only  too  true  of  this, 
malady. 

TREATMENT. 

The  curative  measures  for  inflammatory  diseases  or  ab- 
scesses of  the  tubes  have  not  been,  on  the  whole,  until  within 
a  comparatively  recent  period,  very  satisfactory. 

When  this  affection  complicates  uterine  or  vaginal  ca- 
tarrh, then  the  treatment  that  is  recommended  elsewhere 
for  the  relief  of  these  complaints  should  be  adopted;  quietude 
is  of  paramount  importance,  and  total  continence  must  be 
practiced  by  the  sufferer.  Hot  sitz  baths  and  warm  fomen- 
tations are  important  auxiliaries  in  the  treatment.  Vaginal 
irrigations  of  hot  water,  night  and  morning,  relieve  the  con- 
gestion and  stimulate  the  absorbents  of  the  pelvic  glands. 
Femina  vaginal  capsules  are  a  great  assistance  towards  ac- 
complishing the  same  end;  one  capsule  introduced  into 
the  vagina  at  bedtime  should  be  combined  with  the  other 
treatment. 

If  these  measures  fail  to  accomplish  a  cure,  then  a  surgi- 


DISEASES    OF    THE    FALLOPIAN   TUBES.  201 

cal  operation  may  be  required  as  a  last  resort,  which  con- 
sists in  extirpating  the  diseased  tubes  and  ovaries. 

This  operation  has  given  some  brilliant  results,  but  it  has 
also  hurried  a  great  many  to  an  untimely  grave.  Fool- 
hardy surgeons  or  operators  are  the  rule;  doctors  of  only 
mediocre  talent  worm  themselves  into  positions  that  give 
them  prestige  in  the  community.  Where  nature  refuses  a 
capacity  for  the  acquirement  of  solid  wisdom,  she  seems  to 
compensate  her  creatures  by  endowing  them  with  faculties 
for  cunning  and  intrigue,  that  galvanize  the  spurious  into 
the  apparently  genuine.  They  have  charge  of  hospitals 
and  are  professors  in  colleges,  and  are  ambitious  to  imitate 
the  operations  of  the  European  masters.  On  the  other 
hand  are  the  statistics  of  able  surgeons,  who  seem  to  have 
an  inborn  genius  for  a  special  line  of  operations;  such  a  one 
is  Lawson  Tait,  of  Birmingham,  and  Martin,  of  Berlin. 
Tait  has  had  phenomenal  success  in  cutting  open  the 
abdomen  and  removing  diseased  tubes  and  ovaries.  He 
possesses  the  faculty  and  skill  to  select  only  those  cases  that 
are  especially  suited  for  an  operation,  and  those  that  are  not 
adapted  for  the  knife  are  excluded.  In  the  exercise  of  this 
judgment  the  danger  of  the  operation  is  reduced  to  a 
minimum.  The  tubes  and  ovaries  are  often  so  matted  and 
tied  down  with  inflammatory  adhesions,  that  their  removal 
means  sure  death,  and  does  the  average  surgeon  know  this? 
To  have  the  genius  of  a  Tait  is  to  be  one  in  ten  thousand, 
and  for  this  reason  his  statistics  should  be  neither  a  guide 
nor  an  excuse  for  the  other  nine  thousand  nine  hundred 
and  ninety-nine,  to  attempt  to  do  as  he  does.  To  assume 
that  they  can,  is  as  absurd  as  to  admit  that  our  indigenous 
colonels  of  the  State  militia  can  plan  or  execute  the  cam- 
paigns of  Napoleon. 

Galvanism  or  electricity  has  come  to  the  rescue  of  this  class 
of  cases,  as  a  safe  and  reliable  method  of  treatment;  of 
course  it  takes  more  time  and  patience.  Should  not  this 
outweigh  the  selfish  ambition  of  the  unscrupulous  surgeon 


262  HOME    TREATMENT. 

who  desires  to  boast  of  the  number  of  times  he  has  opened 
the  abdomen,  with  little  compunction  of  the  confiding  lives 
that  he  has  sacrificed? 

I  have  myself  had  abundant  experience  to  be  convinced 
of  the  usefulness  of  electricity  as  a  curative  agent  in  this  class 
of  diseases,  but  I  prefer  to  illustrate  the  treatment  by  quot- 
ing from  a  paper  on  "  The  Value  of  Electricity  as  a  Substi- 
tute for  Laparotomy,"  by  Augustin  H.  Goelet,  M.  D.,  in  the 
New  York  Medical  Journal.     He  says: — 

"  Mrs.  T.,  aged  twenty-six.  Severe  pelvic  pain  referred  to 
left  side;  profuse  leucorrhcea;  prolonged  and  painful  men- 
struation. Diagnosis:  Pyosalpinx  (or  pus)  in  the  left  tube. 
Laparotomy  (opening  the  abdomen)  advised  at  Woman's 
Hospital.  Treatment:  Tube  emptied  into  the  uterus  by 
applications  of  positive  galvanism  to  the  left  horn  of  the 
cavity  of  the  uterus.  Intravaginal  applications  afterwards- 
completed  the  cure.  Duration  of  treatment,  four  months 
Complete  relief  of  pain  followed  the  removal  of  the  pus  from, 
the  tube.  At  the  end  of  the  treatment  she  had  completely 
regained  her  health.  Menstruation  was  normal,  and  symp- 
toms relieved." 


CHAPTER  XXII. 

DISEASES  OF  THE  OVARIES. 

There  is  an  analogy  in  the  reproductive  apparatus,  run- 
ning through  the  whole  animal  and  vegetable  kingdoms. 
The  bulb  at  the  lower  extremity  of  the  pistil  of  a  flower  is 
called  the  ovary,  and  it  contains  the  seed,  which  in  the 
course  of  development  becomes  the  fruit. 

In  the  human  female,  the  ovary  contains  the  seed,  or  germ, 
which,  becoming  fertilized,  develops  into  the  human  embryo, 
or  the  fruit  of  conception. 

The  seeds  of  the  ovaries  are  termed  ova,  or  eggs,  and  the 
organ  or  gland  in  which  the  germs,  or  eggs,  are  prepared  is 
the  ovary. 

In  the  human  female  the  ovaries  are  two  follicular 
glands,  about  the  shape  and  size  of  small  almonds,  situated 
on  each  side  of  the  uterus.  The  follicles,  or  small  sacs,  of 
which  the  ovaries  are  composed,  are  cemented  together  by 
delicate  fibrillar  connective  tissue,  which  is  known  as  the 
stroma  of  the  ovary,  while  the  follicle  is  termed  Graafian 
vesicle,  after  the  name  of  its  discoverer.  Professor  Barry, 
another  investigator,  gave  the  follicles  the  much  better  and 
more  appropriate  designation  of  ovisacs,  because  each  of 
these  capsules  or  follicles  contains  a  single  ovule,  or  little 

egg- 

It  is  carefully  estimated  that  there  are  30,000  Graafian 
follicles  or  ovisacs  in  each  ovary,  of  which  only  an  in- 
significant number  develop  and  rupture  at  each  menstrual 
period.  It  appears,  from  the  researches  of  Valentino  and 
Pflueger,that  the  Graafian  follicles  are  formed  at  a  very  early 
period  of  embryonic  life,  from  a  series  of  minute  tubules, 

(263) 


264  HOME   TREATMENT. 

that  gradually  become  constricted  from,  surrounding  stroma, 
at  regular  intervals ;  the  ova  are  subsequently  developed  in 
the  interior  of  the  follicles. 

Ovarian  cysts  or  tumors  cannot  be  considered  in  a  work 
for  home  treatment,  but  a  desire  must  be  awakened  in  the 
minds  of  thoughtful  readers,  to  learn  the  origin  of  these 
growths,  and  it  seems  to  me  quite  appropriate  at  this  juncture 
of  the  subject,  to  state  that  Professor  Waldeyer,  of  Berlin, 
has  discovered  that  ovarian  tumors  are  developed  from  the 
remnants  of  the  little  tubules  from  which  the  Graafian 
follicles  originate,  so  that  the  cause  or  source  of  these  tumors 
is  already  laid  before  the  patient  is  born;  hence  cannot  be 
attributed  to  any  fault  on  the  part  of  the  afflicted  person. 
From  the  earliest  period  of  intra-uterine  development  up  to 
the  age  of  puberty,  the  growth  of  the  ovaries  is  entirely 
passive,  but  after  that  a  continuous  change  takes  place  in  the 
substance  of  the  ovaries;  the  contents  of  the  ovaries  become 
active  from  the  period  of  puberty,  from  which  dates  the  com- 
mencing aptitude  for  procreation,  until  the  menopause,  or 
final  cessation  of  the  menses,  which,  in  popular  language,  is 
termed  "  change  of  life,"  when  the  aptitude  for  conception 
ceases  with  the  proliferation  of  the  ova. 

The  period  of  fruitfulness  is  characterized  by  the  persist- 
ence of  the  menses,  and  this  terminates,  on  the  average,  in 
the  forty -fifth  year;  during  all  of  this  time  the  little  ova,  or 
eggs,  continually  ripen,  and  at  their  maturity  the  ovisacs,  or 
Graafian  vesicles,  rupture  from  an  increased  secretion  into 
their  cavities.  This  ripening  of  an  egg  and  rupture  of  a 
follicle  corresponds  with  the  monthly  flow.  The  human 
ovum  is  very  small;  the  largest  does  not  measure  above 
1-1 20th  of  an  inch  in  diameter,  and  very  often  it  measures 
only  half  that  size. 

The  situation  of  the  ovary  is  not  fixed  in  the  pelvic 
cavity  with  any  absolute  degree  of  certainty,  but  it  enjoys 
a  degree  of  mobility  that  is  even  greater  than  that  of  the 
womb  itself,  to  which  it  is  attached  by  means  of  the  ovarian 


DISEASES   OF   THE   OVARIES.  2G5 

ligament.  Its  usual  place  is  about  an  inch  from  the  uterus 
and  a  little  backwards.  It  is  partly  surrounded  by  folds 
of  peritoneum,  and  partly  by  the  tissue  that  pads  out  the 
interspaces  between  the  pelvic  organs.  If  we  remember  the 
physiological  fact,  that  at  every  monthly  discharge  of  blood 
from  the  uterus,  which  is  called  menstruation,  an  ovum  or 
egg  ripens  and  an  ovisac  bursts,  we  cannot  fail  to  appreciate 
the  importance  of  the  intimate  relations  that  these  functions 
must  have,  to  the  health  of  the  individual  and  the  perpetua- 
tion of  the  species. 

This  process  of  ovulation  has  the  peculiarity  of  the  first 
stages  of  an  inflammatory  action,  because  the  ovaries  be- 
come congested  whenever  an  ovisac  ruptures. 

Through  the  nervous  sympathy  existing  between  the 
ovaries  and  uterus,  this  too  becomes  congested,  so  that  the 
network  of  uterine  vessels  becomes  so  engorged  that  the 
capillary  blood  vessels  of  the  mucous  membrane  of  the 
womb  rupture,  and  the  hemorrhage  that  is  the  result  con- 
stitutes the  menstrual  flow. 

There  are  three  physiological  processes  concerned  in  the 
menstrual  phenomena:  first,  irritation  and  congestion  of  the 
ovary,  rupturing  the  ovisac;  second,  congestion  of  the  Fal- 
lopian tubes  and  uterus;  third,  consequent  rupture  of  the 
blood  vessels  of  the  mucous  membrane  of  the  uterus  and 
probably  of  the  Fallopian  tubes. 

There  may  be  one  or  more  supernumerary  ovaries  with- 
out disturbing  the  normal  functions;  one  or  both  ovaries 
may  be  congenitally  absent.  The  entire  absence  of  both 
ovaries  is  generally  accompanied  by  deformities  of  so  seri- 
ous a  nature  that  the  newly-born  infant  is  incapable  of  living. 

If  the  defect  is  principally  limited  to  congenital  absence 
of  the  ovaries,  then  there  is  an  absence  of  the  changes  in 
which  puberty  is  recognized;  the  mammary  glands  remain 
flat;  there  is  not  the  roundness  and  fullness  of  the  girl's 
figure  that  signalizes  budding  maidenhood.  The  apparently 
undeveloped  form  and  girlish  characteristics  are  prolonged 


266  HOME    TREATMENT. 

into  the  years  of  adult  age,  and  she  remains  weakly  and 
small. 

In  an  incomplete  or  rudimentary  development,  from  an 
arrested  or  imperfect  evolution  of  the  ovaries,  there  is  often 
a  condition  that  resembles  the  above  very  much;  neither  are 
these  cases  nearly  so  infrequent  as  those  whose  organs  are 
entirely  absent.  The  ovaries  may  persist  in  their  fetal 
state,  or  their  growth  may  be  arrested  at  any  time  before  the 
expected  period  of  puberty.  The  diagnosis  of  this  patho- 
logical condition  must  be  inferred  from  the  undeveloped 
state  of  the  different  organs  and  from  the  absence  of  those 
signs  which  the  approach  of  "the  menses  communicate. 

Displacements  of  the  ovaries  are  often  the  cause  of  suffer- 
ing and  disease,  that  may  excite  symptoms  quite  remote 
from  the  seat  of  trouble.  I  remember  the  case  of  a  young 
woman,  who  had  suffered  from  obstinate  dyspepsia,  which 
subsided  at  once  after  the  removal  of  the  prolapsed  ovary. 
It  has  been  already  alluded  to,  that  these  glands  are  naturally 
very  movable.  Anything  which  increases  their  weight, 
whether  inflammatory  enlargement  or  a  dragging  in  con- 
nection with  some  inflammator}'-  adhesion  to  a  neighboring 
organ,  may  cause  their  displacement  in  various  directions. 
It  happens  that  the  ovary  may  form  the  contents  of  a 
hernia  or  rupture.  A  prolapse  or  descent  is  the  most  com- 
mon form  of  an  ovarian  displacement.  We  often  find  one 
or  the  other  ovary  resting  in  the  pouch  between  the  uterus 
and  rectum,  and  if  the  patient  should  be  troubled  with  con- 
stipation, the  hardened  feces  may  give  rise  to  painful  symp- 
toms in  the  ovaries,  and  pain  in  the  rectum,  while  it  also  is 
one  of  the  causes  of  painful  sexual  relations.  The  irritation 
to  which  the  dislocated  ovary  is  exposed  gives  rise  to  in- 
flammatory affections,  that  may  be  the  cause  of  continual 
suffering. 

INFLAMMATION    OF    THE    OVARIES,    OR    ACUTE    OVARITIS. 

What  inflammation  is  elsewhere,  it  is  again  here  in 
these  glandular  structures. 


DISEASES    OF    THE    OVARIES.  2G7 

I  endeavored  to  point  out  in  the  beginning  of  these  arti- 
cles, that  the  difference  of  inflammatory  diseases  was  not 
due  to  any  difference  in  the  inflammatory  processes,  these 
are  identical,  but  the  modification  of  the  processes  are  due 
to  the  nature  of  the  structure  of  the  tissues  that  are  involved. 

If  the  intelligent  reader  will  bear  this  in  mind,  she  will 
form  a  clear  idea  of  all  the  inflammatory  diseases  that  come 
under  consideration. 

Pathological  microscopists  have  recognized  two  forms  of 
ovaritis,  the  follicular  or  parenchymals,  in  which  the 
Graafian  follicles  or  ovisacs  are  the  seat  of  the  inflammatory 
process,  and  the  interstitial,  in  which  the  intervening  or 
interstitial  connective  tissue,  the  stroma,  between  the  follicles 
is  inflamed.  This  distinction  has  only  a  scientific  interest 
because  it  is  impossible  to  distinguish  one  variety  from  the 
other  in  the  living  subject ;  this  can  only  be  done  with  the 
aid  of  a  powerful  microscope  after  the  suspected  ovary  is 
removed  from  the  body.  Whether  the  inflammation  is 
follicular  or  interstitial  or  both  combined,  it  is  liable  to  de- 
stroy all  the  follicles  or  ovisacs  which  contain  the  ova,  that 
are  essential  to  procreation,  and  the  consequence  will  be 
sterility. 

The  great  functional  activity  to  which  the  ovaries  are  sub- 
jected at  each  menstrual  period,  make  them  extremely  liable 
to  an  inflammatory  process,  so  that  women  cannot  be  too 
careful  of  themselves  at  this  precarious  period.  It  is  during 
menstruation  that  the  ovaries  become  periodically  congested, 
and  this  alone  offers  an  excellent  predisposition  for  inflam- 
mation. As  a  complication  of  other  inflammatory  diseases, 
ovaritis  is  very  common;  it  seems  hardly  probable  that 
there  can  be  an  inflammation  of  a  pelvic  peritoneal  fold  or 
of  the  pelvic  cellular  tissue  in  close  proximity  to  or  sur- 
rounded by  it,  without  involving  the  corresponding  ovary. 
There  cannot  be  a  serious  inflammation  of  the  womb  or  of 
the  Fallopian  tubes  without  being  communicated  to  the 
ovaries,  and  this  is  always  true  of  the  infectious  catarrhs, 
especially  the  gonorrhceal  form. 


2GS  HOME    TREATMENT. 

There  is  a  great  tendency  in  inflammation  of  the  ovaries 
to  suppurate  and  change  the  entire  tissue  of  the  ovary  into 
an  abscess.  Ovarian  abscesses  are  not  much  different  in 
their  behavior  from,  abscesses  in  the  Fallopian  tubes  or 
cellular  tissue.  It  is  claimed  that  they  have  a  greater 
tendency  to  break  into  the  bladder  than  other  pelvic 
abscesses;  this  may  be  due  to  a  displacement  of  the  ovary, 
which  locates  the  gland  near  or  between  the  bladder  and 
uterus,  before  the  advent  of  the  inflammation.  There  are 
no  infallible  signs  that  point  to  the  existence  of  acute  in- 
flammation of  the  ovaries,  owing  to  the  complication  of 
other  inflammatory  processes  in  the  majority  of  cases.  The 
characteristic  pain  of  an  inflamed  ovary  is  of  a  throbbing 
or  pulsating  nature. 

I  cannot  imagine  an  ovaritis  without  at  least  a  circum- 
scribed peritonitis,  and  one  can  hardly  suppose  a  pelvic 
peritonitis  to  exist  without  in  a  certain  degree  compromising 
the  ovary. 

If  the  ovary  has  once  become  inflamed,  whether  alone 
or  as  a  complication  of  other  diseases,  then  the  most  im- 
portant question  to  decide  is  the  existence  of  an  abscess- 
This  can  only  be  recognized  by  an  experienced  and  careful 
specialist,  who  has  trained  his  sense  of  touch,  so  that  he 
can  feel  the  abscess  between  the  fingers  of  one  hand  in  the 
vagina,  and  the  other  making  counter  pressure  on  the 
abdomen.  The  history  of  each  case  must  in  a  measure  de- 
cide the  nature  of  the  fluctuating  tumor,  whether  it  may 
not  be  an  ovarian  cyst  instead  of  an  abscess,  although  an 
abscess  may  have  been  a  small  cyst. 

The  development  and  course  of  different  cases,  present 
various  aspects  for  consideration.  The  enlargement  may 
become  obstinate  to  the  ordinary  methods  of  treatment  and 
assume  the  chronic  form  of  subacute  inflammation.  The 
inflammation  may  spread  from  the  ovary  to  the  peritoneal 
membrane  that  partly  covers  it ;  these  are  the  broad  liga- 
ments of  the  uterus.     This   may   be   the   means   through 


DISEASES   OF   THE   OVARIES.  269 

which  the  organ  may  grow  to  the  surrounding  tissue  and 
adjacent  organs,  so  that  it  becomes  utterly  impossible  to 
move  it  or  even  successfully  extirpate  it  from  its  intimate 
attachments. 

In  other  cases  the  ovary  remains  entirely  free  from  at- 
tachments or  complications,  and  while  it  can  be  generally 
felt  lower  down  pressing  perhaps  on  the  rectum,  it  is  read- 
ily movable  or  replaced.  In  the  majority  of  cases  only  one 
ovary  is  involved,  but  in  these  cases  there  is  a  predisposition 
which  in  a  large  proportion  sooner  or  later  compromises 
also  the  other  ovary  in  a  similar  diseased  process. 

TREATMENT. 

The  treatment  of  this  affection  is  greatly  modified  or  in- 
fluenced by  a  knowledge  of  the  causation  of  the  inflamma- 
tion. In  every  case,  however,  the  patient  should  take  to 
her  bed.  If  there  is  a  profuse  vaginal  secretion  it  should 
be  ascertained  if  the  disease  is  of  infectious  origin,  and 
where  this  is  suspected,  the  vaginal  canal  should  be  thor- 
oughly rinsed  with  an  antiseptic  solution  of  corrosive  chlo- 
ride of  mercury  in  the  proportion  of  one  grain  of  the  sub- 
limate to  two  thousand  grains  or  parts  of  water,  or  about 
fifteen  grains  to  the  half  gallon  of  water.  There  are  tablets 
to  be  had  at  the  drug  stores  which  contain  the  requisite 
amount  of  corrosive  when  added  to  a  given  quantity  of  water; 
these  are  preferable  and  more  convenient  than  the  crude 
drug,  and  as  they  are  a  deadly  poison  they  should  be  kept 
under  lock  and  key.  There  is  nothing  to  equal  the  corro- 
sive for  an  offensive  vaginal  discharge,  for  it  is  the  most  re- 
liable disinfectant  there  is  in  the  entire  pharmacopoea.  Half 
a  gallon  of  this  solution  should  be  used  at  a  time,  and  after 
the  vaginal  canal  has  been  thoroughly  disinfected,  about  a 
pint  of  the  same  solution  must  be  passed  through  the  uter- 
ine cavity  by  means  of  a  double  catheter,  that  has  a  reverse 
flow  and  is  especially  made  for  the  purpose.  To  insure 
against  mercurial  poisoning  I  am  in  the  habit  of  following 


270  HOME    TREATMENT. 

mercurial  irrigations  with  warm  water,  that  was  previously 
sterilized  by  boiling.  One  pint  of  the  simple  water  is  gen- 
erally sufficient  to  displace  all  the  mercurial  water  that 
might  have  remained  in  the  uterine  or  vaginal  cavities. 
These  medicated  irrigations  should  have  an  average  temper- 
ature of  105  degrees  Fahr.  and  be  repeated  daily  for  about 
a  week. 

If  the  vaginal  secretion  is  not  of  a  specific  nature,  then 
the  Femina  antiseptic  uterine  lotion  is  a  safer  remedy. 

Ice  bags  applied  over  the  regions  of  the  painful  ovaries 
check  the  acute  inflammation  from  going  into  suppuration 
and  forming  an  abscess.  Should  the  latter  be  found  to  exist, 
it  should  be  opened  by  means  of  a  trocar  or  aspirator.  The 
bowels  should  be  kept  free  by  taking  a  daily  dose  of  Femina 
laxative  tablets. 

CHRONIC    OVARITIS. 

If  an  acute  inflammation  does  not  terminate  in  prompt 
recovery  or  an  abscess  it  may  lose  its  fiery  nature  and  tone 
down  into  a  low  grade  of  prolonged  congestion  which  does 
not  go  on  to  the  production  of  suppuration.  This  would 
constitute  the  chronic  form  of  inflammation. 

It  does  not  follow  that  all  chronic  inflammations  are  pre- 
ceded by  the  acute  form,  for  there  are  inflammations  that 
are  subacute  from  the  beginning,  that  is,  that  there  is  not 
the  heat  nor  feverishness  in  the  tissues  which  is  one  of  the 
principal  features  of  the  acute  process. 

Chronic  inflammation  of  the  ovaries  is  much  more  fre- 
quent as  an  original  or  individual  affection,  than  the  pre- 
ceding form.  A  peculiar  feature  of  this  affection  is  a  grad- 
ual growth  or  enlargement  of  the  ovary,  all  the  way  from  a 
moderate  swelling  to  a  good-sized  orange.  There  has  been 
some  discussion  as  to  the  particular  tissue  of  the  ovaries 
that  is  involved  in  the  inflammatory  process,  whether  it  is 
the  interfollicular  structure  or  the  follicules  or  ovisacs  them- 
selves; practically  the  solution  of  this  question  has  no  bear- 


DISEASES   OF   THE   OVARIES.  271 

ing  on  the  treatment,  although  it  may  have  an  influence  on 
the  function  of  the  organ,  which  may  be  more  injuriously 
affected  by  the  latter  than  the  former  variety.  The  disease 
occurs  almost  exclusively  after  the  age  of  puberty  and  dur- 
ing the  period  of  sexual  activity.  It  is  not  as  often  met  in 
the  unmarried  as  in  the  married,  and  with  the  latter  it  is 
more  prevalent  in  the  first  years  of  married  life.  Inordi- 
nate sexual  indulgence  is  a  frequent  exciting  cause,  and 
when  this  is  coupled  with  pernicious  means  that  are  em- 
ployed for  preventing  conception,  it  becomes  still  more  fre- 
quent, 

Chronic  inflammation  of  the  vagina,  womb,  and  of  the 
Fallopian  tubes  is  often  transferred  to  the  ovaries. 

The  infectious  catarrh  to  which  the  genital  tract  of  the 
female  is  more  or  less  exposed  from  a  lack  of  proper  clean- 
liness of  her  own  person,  or  a  gonorrhceal  infection  from 
her  male  companion,  show  a  peculiar  tendency  to  gradually 
spread  the  inflammatory  processes  to  the  ovaries.  Some 
careful  observation  has  established  the  fact  that  an  appar- 
ently cured  gonorrhceal  infection  in  the  male  may,  after  a 
year  or  two,  excite  a  gonorrhceal  catarrh  in  the  genitals  of  the 
female;  a  great  many  diseases  of  the  ovaries  have  been 
traced  to  this  source  of  infection. 

As  gonorrhoea  is  not  an  uncommon,  affection  among  the 
male  portion  of  the  community,  it  is  not  sufficient  for  the 
intelligent  members  of  the  medical  profession  to  know  of 
these  dangers  of  infection,  but  every  man  and  woman  should 
be  apprised  of  the  great  danger  there  is  of  infecting  the 
marital  chamber  with  the  pollution  of  the  brothel. 

The  symptoms  of  chronic  ovaritis  are  more  or  less  de- 
pendent on  the  causation  of  each  individual  case. 

Sometimes  it  is  traced  to  the  fiery  stage  of  the  acute  af- 
fection, while  in  other  instances  it  can  be  laid  to  some  indis- 
cretion during  the  menstrual  flow,  then,  again,  it  may  have 
developed  itself  so  stealthily  that  the  greatest  acumen  and 
skill  are  required  to  detect  its  origin.     The  most  important 


272  HOME    TREATMENT.. 

and  constant  sign  is  a  steady  pain  in  one  or  both  ovaries. 
When  this  pain  is  violent,  it  shoots  toward  the  back  and 
rectum  and  down  the  thighs.  The  pain  becomes  height- 
ened from  an  accumulation  of  feces  in  the  rectum,  which  a 
habitual  constipation  entails.  Marital  excesses  near  the  ap- 
proach of  the  menstrual  period  or  shortly  after  the  disap- 
pearance of  the  menses  are  quite  likely  to  precipitate  the 
painful  symptoms.  The  bladder  sympathizes  in  a  certain 
proportion  of  cases,  so  that  there  is  a  frequent  desire  to  pass 
water.  In  the  course  of  time  the  distressful  symptoms  that 
have  been  enumerated  derange  the  digestive  apparatus ;  the 
patients  lose  their  appetite  and  decline  into  a  debilitated  and 
nervous  state,  so  that  one  or  the  other  hysterical  phenome- 
non become  more  or  less  prominent  in  persons  of  a  nervous 
temperament. 

Sterility  is  a  rule  with  this  class  of  women,  even  if  there 
is  only  one  ovary  affected ;  this  would  indicate  that  the  ap- 
parently healthy  one  sympathizes  with  the  other,  or  an  ac- 
companying catarrh  of  the  uterus  or  tubes  may  prevent  the 
passage  of  the  fertilizing  germ.  If  both  ovaries  are  inflamed, 
then  it  is  quite  natural  to  suppose  that  the  delicate  follicles 
and  their  contents,  the  ova,  become  destroyed  or  so  altered 
that  they  no  longer  answer  the  purpose  of  reproduction. 
It  is  seldom  that  one  meets  a  chronic  ovaritis  without  a 
uterine  catarrh,  and  how  much  this  contributes  to  the  ste- 
rility is  not  easy  to  tell. 

TREATMENT. 

The  course  of  this  affection  in  the  majority  of  cases  is 
favorable.  If  the  treatment  is  intelligently  administered, 
the  pain  and  congestion  gradually  subside,  and  as  this  class 
of  patients  have  generally  learned  from  sad  experience  that 
negligence  or  indiscretion  on  their  part  will  excite  a  relapse, 
they  soon  learn  to  avoid  these,  so  that  they  enjoy  compara- 
tive immunity  from  suffering  for  a  considerable  length  of 
time. 


DISEASES   OF   THE   OVARIES.  273 

There  is  a  smaller  proportion  of  cases  whose  unfortunate 
surroundings  or  lack  of  intelligence  makes  remedial  meas- 
ures of  no  avail.  These  poor  women  have  neither  respite 
from  physical  labor  nor  freedom  from  the  animal  passions  of 
their  husbands,  and  thus  living  in  constant  pain  they  be- 
come drooped  in  spirit  and  reduced  in  vigor,  so  that  they 
fall  an  easy  victim  to  any  intercurrent  affection  that  may 
attack  them. 

In  proportion  as  the  patients  can  give  their  diseased 
ovaries  freedom  from  irritating  influences  are  the  chances 
for  their  complete  recovery  increased. 

To  accomplish  this  object,  quietude  in  the  recumbent 
posture,  sexual  abstinence  and  a  free  daily  stool  form  the 
basis  for  recovery.  If  there  is  much  pelvic  pain,  this  is  best 
controlled  by  means  of  the  ice  bag,  4x6  inches  in  size,  of 
which  one  on  each  side,  wrapped  in  one  thickness  of  flannel, 
should  be  applied  to  the  groin  or  region  of  the  ovaries; 
cold-water  compresses,  thoroughly  wrung,  so  as  not  to  drip, 
and  covered  with  flannel  so  as  to  keep  the  bed  covering  dry, 
are  also  advisable,  but  only  a  poor  substitute  for  the  ice. 

Iodoform  suppositories  greatly  stimulate  the  absorption 
of  the  inflammatory  exudation ;  one  of  these  should  be  in- 
troduced into  the  vaginal  canal  each  day.  If  the  patient 
can  get  up  without  any  painful  symptoms,  she  should  take 
the  hot  sitz  bath  for  ten  or  fifteen  minutes  daily,  and  as  a 
general  tonic,  this  is  a  useful  prescription. 

NO.    XI. 

Take:  Bromide  of  sodium 2  drams 

Iodide  of  potassium 1  dram 

Comp.  tinct.  of  gentian 2  ounces 

Water,  sufficient  to  make 8  ounces 

Mix.     A  tablespoonful  three  times  a  day. 

There  is  no  affection  in  the  entire  category  of  diseases  of 
women,  in  which  the  confidence  of  women  has  been  more 
abused  by  specialists,  than  by  meddlesome  surgical  inva- 
sions, for  the  extirpation  of  one  or  both  ovaries,  to  cure  real 
18 


274  HOME   TREATMENT. 

or  imaginary  diseases  of  these  glands.  There  is  a  veritable 
mania  among  surgeons  for  this  operation,  but  the  conserva- 
tive portion  of  the  profession  are  awakening  to  a  conviction 
that  this  is  entirely  wrong,  and  a  presumption  on  profes- 
sional license  that  is  altogether  unpardonable. 

If  these  castrations  were  confined  to  the  removal  of 
ovaries  that  are  unmistakably  degenerated  or  diseased,  and 
that  had  resisted  intelligent  treatment  for  some  time,  there 
would  not  be  the  same  objection,  but  when  ovaries  are  re- 
moved that  are  apparently  healthy,  but  through  ignorance 
or  incompetency  are  supposed  to  be  the  offending  members, 
then,  I  say,  that  is  an  outrage. 

There  are  a  great  many  women  who  have  been  subjected 
to  the  dangers  of  a  so-called  normal  ovariotomy,  without  be- 
ing in  the  least  benefited  by  the  operation.  The  symptoms 
which  the  extirpation  of  their  ovaries  was  to  relieve,  per- 
sisted as  before,  and  they  discovered,  when  it  was  too  late, 
that  spaying  is  not  a  panacea  for  the  ills  that  suffering 
women  are  heir  to. 

The  ovaries  are  in  delicate  sympathy  with  all  the  other 
pelvic  organs,  and  when  these  are  affected  there  may  be 
more  or  less  pain  in  one  or  both  of  these  glands.  They 
may  be  even  the  seat  of  a  neuralgic  affection  without  any 
structural  change  in  the  organ  or  in  the  neighboring  or- 
gans. This  would  be  simply  a  reflex  sign  of  a  general  de- 
bilitated condition,  and  to  mistake  all  these  for  ovarian 
disease  and  to  make  it  an  excuse  for  their  removal,  is  not 
warranted  by  careful  observation.  Electricity  is  now  com- 
ing to  the  front  as  one  of  the  most  valuable  remedies  for 
just  this  class  of  affections,  and  I  will  give  a  detailed  ac- 
count of  the  nature  of  this  remedy  and  the  requirements  for 
its  successful  application,  which  persons  who  speak  lightly 
of  its  virtue,  never  acquire  nor  take  the  pains  to  possess. 


CHAPTER  XXIII. 

PERIMETRITIS   AND  PELVIC  PERITONITIS. 

The  peritoneum  is  a  delicate,  thin,  serous  membrane, 
that  lines  the  whole  internal  surface  of  the  abdomen  and 
envelopes  more  or  less  completely  all  the  abdominal  organs, 
so  that  the  viscera  glide  smoothly  against  each  other  with 
the  least  possible  friction.  The  peritoneum  dips  down  al- 
most midway  into  the  true  pelvis,  and  its  boundaries  con- 
stitute also  the  limit  of  the  abdominal  cavity.  That  portion 
of  the  general  peritoneum,  which  partly  invests  all  the 
pelvic  organs,  is  distinguished  from'  the  other  by  the  term 
pelvic  peritoneum.  When  the  entire  membrane  becomes  the 
seat  of  inflammation,  the  affection  is  a  general  peritonitis, 
but  when  the  inflammation  is  limited  to  the  organ  that  it 
infolds,  the  prefix  peri,  signifying  around,  is  compounded 
with  the  name  of  the  organ,  and  the  suffix  itis  is  added, 
which  indicates  that  the  peritoneal  covering  of  such  an 
organ  is  inflamed,  hence,  the  term  peri-metra-itis  means 
inflammation  of  the  peritoneum  around  the  womb. 

Pelvic  peritonitis  means  that  the  peritoneum  of  the  en- 
tire pelvic  cavity  is  involved  in  the  inflammatory  process. 
This  may  include  the  peritoneal  covering  of  all  the  other 
pelvic  organs  besides  that  of  the  womb  as  well  as  the  peri- 
toneal folds,  that  enter  into  the  formation  of  the  broad  and 
other  ligaments  of  the  pelvic  organs. 

Perimetritis  is  rarely  an  independent  uncomplicated  dis- 
ease, but  oftener  a  complication  of  inflammation  of  the 
womb,  the  Fallopian  tubes,  ovaries,  or  of  the  cellular  tissue 
that  surrounds  the  organs  and  in  which  they  are  imbedded. 
The  pelvic  peritoneum  and  the  cellular  tissue  are  so  inti- 

(275) 


276  HOME    TREATMENT. 

mately  connected  with  each  other  by  means  of  their  ves- 
sels, nerves  and  lymphatics,  that  an  inflammation  easily 
runs  from  one  tissue  to  another. 

If  we  now  inquire  into  the  causes  which  induce  this  dis- 
ease, we  shall  find  that  there  is  not  a  single  inflammatory 
disease  of  any  of  the  pelvic  organs  that  may  not  lead  to  its 
inauguration.  Metritis  after  an  abortion  or  a  confinement 
is  a  fruitful  source,  so  are  all  the  other  causes  that  operate 
in  exciting  metritis  indirectly  concerned  in  this  affection. 
Since  etiology  or  the  causation  of  diseases  has  been  made  a 
special  study  in  connection  with  this  subject,  some  startling 
discoveries  have  been  made  in  regard  to  the  origin  of  pelvic 
peritonitis. 

Dr.  Noeggerath,  of  New  York,  has  found  in  the  majority 
of  cases  that  came  under  his  observation,  that  pelvic  peri- 
tonitis, either  acute  or  chronic,  is  due  to  gonorrhceal  in- 
fection. He  claims  that  gonorrhoea  in  the  male  is  in  the 
majority  of  instances  incurable ;  although  it  may  be  appar- 
ently cured,  it  continues  as  a  latent  affection  which  regularly 
infects  his  female  companion.  This  shows  itself  at  first  as- 
a  slight  vaginal  catarrh,  which  gradually  and  stealthily 
spreads  to  the  cavity  of  the  womb,  thence  to  the  Fallopian 
tubes  and  ovaries  and  afterwards  involving  the  pelvic  peri- 
toneum, for  it  must  be  remembered  that  the  Fallopian  tubes 
open  directly  into  the  peritoneal  cavity. 

Dr.  Noeggeratli  has  collected  statistics  that  agree  with 
those  of  the  celebrated  French  physician,  Ricord,  which 
show  that  on  an  average  80  per  cent  of  the  male  population 
have  had  gonorrhoea,  and,  believing  themselves  cured,  when 
not,  enter  into  married  relations,  and  unwittingly  infect  their 
wives.  He  says  that  "it  has  come  to  pass  that  young  ladies 
dread  to  marry,  because  all  their  friends  become  invalids 
soon  after  the  nuptial  rites."  The  late  Professor  Schroeder, 
of  the  Berlin  Gynecological  clinic,  says  that  "the  assertions 
of  Noeggerath  are  extravagant,  but  that  he  must  particularly 
emphasize  that  chronic  inflammatory  conditions  of  the  in- 


PERIMETRITIS   AND    PELVIC   PERITONITIS.  277 

ternal  female  genitals,  like  catarrh  of  the  vagina  and  uterus, 
metritis  and  perimetritis,  are  extraordinarily  frequent  results 
of  gonorrhceal  infection." 

I  am  inclined  to  think,  from  my  own  experience,  that  the 
more  conservative  view  of  Professor  Schroeder  is  perfectly 
safe  and  true,  but  if  Dr.  Noeggerath  made  due  allowance  for 
the  number  of  invalids  among  newly-married  people  whose 
uterine  diseases,  especially  pelvic  peritonitis,  were  traceable  to 
criminal  abortions  and  monthly  probing  of  their  uterine 
cavities  to  induce  the  menstrual  flow,  his  views  would  about 
coincide  with  those  of  the  distinguished  Berlin  authority. 
These  catarrhal  affections  cause  sterility,  and  if  conception 
supervenes,  then  there  is  a  likelihood  of  a  miscarriage  or  a 
premature  birth,  or  a  perimetritis  during  pregnancy  or  con- 
finement. 

Menstrual  disorders  in  which  the  flow  is  either  obstructed 
or  suppressed  may  also  give  rise  to  perimetritis. 

Blood  poisoning  from  criminal  operations  contributes  its 
share  in  the  causation.  Trumatic  agencies,  like  blows,  falls, 
lacerations,  and  other  injuries  during  labor,  may  result  in 
pelvic  peritonitis. 

Either  too  hot  or  too  cold  vaginal  irrigations  have  given 
rise  to  this  affection,  and  injections  into  the  cavity  of  the 
womb  for  medicinal  purposes,  in  which  some  of  the  fluid 
escaped  through  the  Fallopian  tube  into  the  peritoneal  cav- 
ity, has  caused,  in  several  instances,  fatal  peritonitis.  The 
inflammation  of  the  womb  after  childbirth  invariably  in- 
volves the  peritoneum.  The  course  and  duration  of  this 
disease  is  by  no  means  uniform. 

The  disease  under  consideration  is  an  example  of  an 
acute  inflammation  affecting  a  serous  membrane. 

I  have  taken  pains  to  inform  the  reader  that  the  phe- 
nomena of  inflammation  are  always  the  same,  but  that  the 
results  are  modified  by  the  peculiarity  of  the  structure  of 
which  the  tissues  are  composed. 

A  serous  membrane  differs  completely  from  a  mucous 


278  HOME    TREATMENT. 

membrane,  inasmuch  as  it  contains  neither  mucous  glands 
nor  mucous  cells,  and  for  that  reason  can  never  be  the  seat 
of  catarrh ;  instead  of  this,  it  possesses  the  power  to  secrete 
or  transude  the  serous  portion  of  the  blood,  hence  its  name. 
The  serous  membrane  in  a  healthy  condition  has  only  a 
sufficient  quantity  of  secretion  to  moisten  the  membrane, 
but  not  to  furnish  any  appreciable  quantity  of  fluid.  If  the 
secretion  takes  place  as  a  result  of  congestion,  especially 
when  this  congestion  is  due  to  an  obstruction  to  the  return 
of  blood  from  heart  or  liver  disease,  it  is  secreted  in  such 
large  quantities  that  it  constitutes  dropsy. 

Under  the  stimulating  influence  of  the  inflammatory 
process,  a  similar  secretion  is  the  result,  only  that  it  contains 
also  fibrin,  which  renders  the  secretion  or  exudation  sponta- 
neously coagulable,  and,  further,  possesses  the  capability  of 
passing  into  the  condition  of  an  organized  tissue,  either 
fibrous  or  granular,  and  thus  forming  false  membranes  on 
inflamed  surfaces,  or  solidifying  into  tumors  or  swellings. 

These  inflammations  have  their  various  degrees  of  sever- 
ity, from  a  temporary  reddening  of  the  membrane  with 
barely  enough  effusion  of  inflammatory  material  to  cause  a 
thin  layer  of  deposit,  to  extensive  and  violent  attacks,  that 
pour  out  enormous  quantities  of  effusion  or  exudation,  so  as 
to  fill  the  entire  pelvic  cavity  with  a  solid  mass.  The  na- 
ture of  the  inflammatory  material  may  be  purulent  from  the 
beginning,  because  its  origin  was  of  an  infectious  or  septic 
nature. 

Suppuration  may  develop  slowly  and  lead  to  an  abscess; 
this  may  open  or  break  into  the  peritoneal  cavity,  causing 
general  septic  peritonitis,  which  will  cause  death  in  a  few 
hours  or  days.  The  abscess  may  also  suppurate  and  break 
into  some  of  the  adjacent  organs  or  tunnel  its  way  in  dif- 
ferent circuitous  routes,  being  guided  in  its  course  by  the 
pelvic  and  muscular  fasciae,  so  that  it  may  perforate  at  the 
groin,  show  itself  at  the  inside  of  the  thighs,  or  in  the  lum- 
bar region  near  the  kidneys.     It  ruptures  most  frequently 


PERIMETRITIS    AND    PELVIC    PERITONITIS.  279 

into  the  rectum,  next  in  frequency  into  the  vagina  and  into 
the  bladder.  I  had  a  case,  that  came  under  my  treatment, 
in  which  both  rectum  and  vagina  were  perforated,  and  puru- 
lent matter  discharged  from  both  fistula?;  under  appropriate 
treatment  the  patient  recovered  completely. 

If  the  inflammation  is  not  of  infectious  origin,  the  exu- 
dation gradually  becomes  absorbed,  and  each  day  grows  less, 
until  finally  nothing  but  a  few  fibrous  bands  can  be  felt,  and 
these  too  may  disappear  in  time. 

The  symptoms  of  perimetritis  depend  in  a  great  meas- 
ure on  the  nature  and  severity  of  the  attack. 

There  are  three  distinct  stages  of  this  disease,  and  each 
has  its  characteristic  symptoms.  The  first  stage  is  that  of 
inflammatory  congestion,  which  is  generally  ushered  in  with 
a  distinct  chill  or  a  chilly  feeling,  which  is  speedily  followed 
by  a  high  fever  and  a  rapid  pulse.  The  lower  abdominal 
region  becomes  exceedingly  sensitive  and  very  painful  on 
pressure;  the  abdomen  becomes  tympanitic  or  bloated,  and 
it  is  a  relief  for  the  patient  to  draw  her  limbs  up,  so  as 
to  relax  the  abdominal  walls.  A  vaginal  examination  in 
this  stage  gives  only  negative  results;  there  is  nothing  but  a 
painful  sensitiveness,  great  heat,  and  the  vaginal  walls  are 
puffed  or  swollen;  there  is  as  yet  no  inflammatory  exuda- 
tion that  can  be  felt  by  the  finger. 

After  the  affection  has  lasted  one  or  more  days,  the  sec- 
ond stage  of  the  disease  is  recognized,  this  is  the  effusion  or 
exudation.  The  characteristic  physical  signs  of  effusion  are 
the  only  absolute  proof  of  the  existence  of  this  disease. 
These  signs  are  (1st)  an  immovable  fixed  state  of  the  womb, 
which  is  quite  the  contrary  to  its  natural  healthy  state,  that 
permits  of  a  mobility  in  all  directions;  (2d)  a  hard,  non- 
bulging  condition  of  the  tissues  that  surround  the  womb,  so 
that  the  impression  which  one  receives  gives  the  idea  of  all 
the  pelvic  organs  being  cast  or  set  in  wax,  because  everything 
is  glued  down  and  immovable;  (3d)  an  indistinct  fullness  is 
felt  by  the  patient,  high  up  in  the  pelvis ;  this  is  the  free 


280  HOME   TREATMENT. 

exudation  of  the  inflammatory  material,  which  has  now  be- 
come solidified  and  has  some  characteristics  of  a  tumor. 
This  may  push  the  organ  forward  or  to  either  side  or  sur- 
round the  womb  on  all  sides. 

The  third  stage  is  that  of  absorption  or  the  gradual  dis- 
appearance of  the  exudation;  this  is  usually  a  slow  process, 
and  may  take  from  three  to  six  months.  I  have  known  res- 
idues of  the  exudation,  in  the  form  of  fibrous  bands  or  adhe- 
sions or  solid  lumps  to  remain  for  years  in  the  pelvic  or 
peritoneal  cavity.  These  bands  may  tie  or  fix  the  uterus  to 
the  rectum  or  to  the  pelvic  walls,  so  that  it  will  resist  all  or- 
dinary efforts  to  replace  it.  Pelvic  hematocele,  or  an  effusion 
of  blood  into  the  pelvic  peritoneum,  inclosed  either  by  ana- 
tomical structures  or  previously-existing  inflammations, 
greatly  resembles  the  sero-fibrinous  exudation  of  perimetritis. 
The  pallor  of  the  countenance  aided  by  other  signs  of  hem- 
orrhage must  assist  in  distinguishing  the  affections. 

Chronic  perimetritis  is  developed  in  numerous  affections 
of  the  womb  that  exert  a  continuous  irritation  of  its  peri- 
toneal covering.  These  are  fibroid  and  malignant  tumors, 
painful  and  difficult  menstruation,  as  well  as  enlargement 
of  the  tubes  and  ovaries.  Inflammation  of  the  uterus  and 
a  discharge  of  blood  or  matter  through  the  tubes  and  into 
the  peritoneal  cavity,  may  bring  about  a  chronic  pelvic 
peritonitis  from  the  beginning. 

Chronic  perimetritis  or  chronic  pelvic  peritonitis,  for  the 
terms  are  often  interchangeable,  is  most  abrupt  in  its  de- 
velopment, because  it  is  not  heralded  by  fiery,  acute  febrile 
symptoms,  but  a  close  inquiry  will  usually  recall  to  the 
minds  of  patients  the  commencement  of  the  trouble.  The 
fact  that  the  peritoneum  is  also  reflected  on  the  bladder, 
causes  an  irritability  of  this  organ,  to  be  the  first  and  only 
symptom,  for  quite  a  while.  There  is  nothing  stereotyped 
in  the  development  of  any  disease,  so  that  the  symptoms 
may  or  may  not  be  painful  from  the  beginning.  The  pains 
in  the  pelvis  are  more  or  less  continual,  there  is  an  incapacity 


PERIMETRITIS    AND    PELVIC    PERITONITIS.  281 

for  bodily  exertion,  the  bowels  are  out  of  order,  either  there 
is  constipation  or  a  chronic  diarrhoea;  these  morbid  condi- 
tions destroy  the  appetite  and  the  patient  becomes  lean  and 
weakly.  From  time  to  time  all  these  abnormal  signs  be- 
come aggravated,  so  that  the  sufferer  may  be  forced  to  take 
to  her  bed. 

Some  women  have  great  powers  of  resistance  and  endure 
suffering  with  great  fortitude,  so  that  they  are  compara- 
tively free  from  harassing  pain,  although  their  pelvic  organs 
are  tied  down  by  inflammatory  adhesions,  and  unless  they 
lift  or  make  other  unusual  muscular  efforts,  that  increase 
the  intra-abdominal  pressure,  so  as  to  dragon  the  adhesions, 
they  suffer  little  or  no  pain.  Another  sign  of  chronic  peri- 
metritis is  painful  intercourse,  which  jars  the  adhesions, 
and  this  is  particularly  the  case  if  the  womb  comes  down 
quite  low.  The  danger  to  be  apprehended  is  that  no  one 
knows  at  what  moment  some  indiscretion  will  light  up  an 
acute  attack  with  all  its  serious  consequences. 

In  view  of  the  possibility  of  any  local  or  circumscribed 
peritonitis  becoming  general,  and  as  such  may  prove  fatal, 
the  importance  of  recognizing  it  in  its  first  stage,  or  early, 
becomes  readily  apparent. 

Preventive  measures  of  circumscribed  or  local  peritonitis 
are  to  be  found  in  avoiding  the  causes  that  have  been  referred 
to  as  inducing  the  affection  under  consideration,  among 
which,  criminal  abortions  are  the  most  fruitful.  It  seems  to 
me  that  if  women  were  cognizant  of  the  dangers  that  threaten 
them,  they  would  not  only  be  more  careful  in  observing  the 
ordinary  rules  of  health,  but  they  would  voluntarily  shrink 
from  committing  crimes  that  not  only  stain  their  souls  with 
the  blood  of  their  own  kindred,  but  also  entail  disease  and 
death,  that  unexpectedly  waft  their  spirits  into  the  presence 
of  their  Creator,  whose  laws  they  have  outraged.  How 
often  have  I  been  told  by  women  who  lay  prostrated  on 
their  death  bed,  "  O  doctor,  I  did  not  know  that  the  in- 
duction of  an  abortion  was  a  crime  and  dangerous,  because 


282  HOME   TREATMENT. 

the  person  who  performed  the  operation  told  me  that  it  was 
neither  dangerous  nor  criminal."  Alas!  poor  woman,  there 
is  no  greater  crime,  and  nothing  more  pernicious  to  your 
health  and  life;  would  that  others  would  only  learn  and  profit 
from  the  inexorable  fate  into  which  your  delusions  enticed 
you. 

TREATMENT. 

The  treatment  in  this  affection,  when  prompt  and  intelli- 
gently administered,  offers  every  chance  of  success.  In  the 
acute  stage  of  pelvic  peritonitis,  we  must  resort  to  remedies 
that  promptly  conteract  the  inflammatory  action.  The  in- 
ternal administration  of  opium  or  some  morphine  prepara- 
tion is  invariably  demanded,  not  only  to  relieve  the  pain 
but  also  to  completely  check  or  constipate  the  bowels,  so 
that  their  peristaltic  action  is  entirely  suspended,  for  their 
motion  would  irritate  the  peritoneum.  Dr.  McMunn's 
elixir  of  opium  in  one-half  to  one  teaspoonful  doses  should 
be  given  every  four  hours,  until  the  pain  is  relieved  and 
the  bowels  controlled. 

Rubber  ice  bags  should  be  applied  to  the  lower  abdomi- 
nal region.  This  course  of  treatment  will  generally  limit 
and  check  the  inflammatory  process  in  a  few  days;  then  the 
bowels  should  be  gently  moved  every  day,  with  an  enema  of 
warm  water  impregnated  with  a  little  soap;  after  which, 
complete  quietude  in  bed  for  another  week  or  two,  will  com- 
plete the  cure. 

Chronic  perimetritis  must  be  treated  according  to  its 
complications;  should  there  be  a  gonorrhceal  infection,  then 
what  was  said  of  the  treatment  of  this  complaint  elsewhere, 
applies  with  equal  force  to  these  cases.  The  patient's  strength 
must  now  be  an  object  of  jealous  solicitude.  The  diet  must 
be  of  the  most  nourishing  nature,  and  milk  or  egg  punch 
should  be  the  principal  food,  at  regular  intervals  of  four 
hours,  alternating  with  strong  soups  or  beef  teas,  to  which  a 
raw  egg  thoroughly  beaten  should  first  be  added. 

Vaginal  and  uterine  catarrhs,  if  they  exist,  require  the 
attention  that  is  recommended  in  the  preceding  pages. 


PERIMETRITIS    AND    PELVIC    PERITONITIS.  283 

Warm  compresses  or  fomentations  and  daily  hot  sitz 
baths  are  of  great  value  in  chronic  perimetritis,  for  they 
stimulate  the  healing  process  and  the  absorption.  The 
bowels  must  now  be  daily  moved,  and  here  I  prefer  the 
patient  to  employ  simply  warm  water  enema  in  tolerably 
large  quantities  slowly  injected,  until  a  quart  or  more  of 
the  fluid  has  been  thrown  into  the  rectum;  these  enemas  will 
not  only  move  the  bowels,  but  also  stimulate  the  healing 
process.  If  the  patient  lies  on  the  left  side  while  these  in- 
jections are  taken  or  given,  the  enema  flows  higher  up,  and 
it  should  be  retained  for  a  reasonable  length  of  time. 
These  enemas  should  only  be  taken  every  other  day,  and 
between  days  a  suitable  dose  of  purgative  elixir.  Tincture 
of  iodine  can  be  applied  to  the  groins  every  second  day,  or 
iodoform  suppositories  introduced  into  the  vagina.  Mud 
baths  are  also  very  beneficial  in  removing  old  inflammatory 
adhesions. 

If  the  exudation  suppurates  and  an  abscess  forms,  it 
should  be  freely  opened  as  soon  as  possible.  This  can  gen- 
erally be  best  accomplished  through  the  vagina,  but  if  there 
be  a  tendency  of  the  abscess  to  point  towards  the  groin,  then 
this  situation  would  be  preferable,  although  I  prefer,  in  even 
these  cases,  to  make  a  counter  opening  in  the  vagina,  for 
this  precludes  the  possibility  of  the  abscess  sacking  or  bur- 
rowing further  into  the  tissue.  The  cavity  of  the  abscess 
should  be  thoroughly  rinsed  out  with  a  2  per  cent  carbolic 
acid  or  a  1  to  2,000  corrosive  sublimate  solution,  and  if  there 
is  a  tendency  in  the  abscess  to  close  before  its  cavity  is  healed 
out,  a  rubber  drainage  tube  should  be  inserted,  so  as  to  give 
the  pus  all  the  possible  facility  to  escape.  If  the  abscess 
breaks  into  the  bladder  or  into  the  rectum,  then  a  counter 
opening  into  the  vagina  will  greatly  insure  and  expedite 
recovery. 

Sometimes  the  ovaries  and  tubes  become  diseased  as  a 
result  of  the  perimetritic  inflammation;  this,  then,  becomes 
a   subject  of   special   inquiry   and    treatment.      It  should 


284  HOME   TREATMENT. 

hardly  be  necessary  to  remind  the  reader  that  sexual  rela- 
tions are  to  be  suspended  while  there  is  the  least  sign  of  the 
affection  to  be  discerned.  Although  old  adhesions  and  dis- 
placements, the  result  of  old  chronic  pelvic  peritonitis,  are 
often  naturally  and  permanently  removed  through  a  super- 
vening pregnancy,  the  intelligent  use  of  the  galvanic  cur- 
rent will  also  accomplish  that  end. 


CHAPTER  XXIV. 

PELVIC  CELLULITIS  OR  PARAMETRITIS. 

The  term  cellular  was  given  to  this  tissue,  because  under 
the  microscope  it  shows  large  meshes  or  cell-like  cavities, 
that  are  also  termed  areoke,  hence,  the  tissue  is  often  called 
areolar  tissue;  it  is  also  called  connective  tissue,  because  it  com- 
bines all  the  different  organs  and  structures  of  the  body  to- 
gether. It  is  very  elastic  and  contractile,  and  by  the  fluid 
which  it  contains  in  its  areolae,  motion  of  parts  on  each 
other  is  facilitated. 

Professor  Virchow  has  applied  to  it,  in  the  region  of  the 
womb  or  pelvis,  the  term  parametric  tissue,  from  the  Greek 
prefix  para,  beside,  and  the  Latin  metra,  the  womb,  signify- 
ing the  tissue  near  and  around  the  womb,  from  which  the 
Germans  derive  parametritis,  instead  of  the  English,  who 
employ  pelvic-cellulitis,  each  meaning  one  and  the  same  thing, 
namely,  inflammation  of  the  cellular  or  connective  tissue  in 
the  pelvis  or  around  the  womb. 

The  female  pelvic  organs  have  interspaces  between  the 
bladder,  vagina  and  uterus  in  front,  and  the  uterus,  vagina 
and  rectum  behind,  also  on  both  sides,  between  the  womb, 
ovaries,  and  the  folds  of  the  broad  ligaments,  and  lastly,  1h>- 
tween  these  organs  and  the  walls  of  the  pelvic  cavity  are 
interspaces.  These  interspaces  are  filled  in  or  padded  out 
by  loose  cellular  tissue.  M.  Nonat,  a  celebrated  French 
authority,  has  described  this  in  a  beautiful  figure,  by  say- 
ing that  "the  organs  of  reproduction  float  in  an  atmosphere 
of  cellular  tissue."  This  is  indeed  so,  and  a  consideration 
of  an  inflammatory  condition  of  this  structure,  is  to  con- 
clude the  inquiry  into  the  inflammatory  diseases  peculiar  to 
women. 

(285^ 


286  HOME    TREATMENT. 

Pelvic  cellulitis  is  one  of  those  diseases  for  the  compre- 
hension of  which  we  are  particularly  indebted  to  the  re- 
searches of  modern  pathologists,  who  have  discovered  that 
infectious  germs  are  the  cause  of  numerous  diseases;  pelvic 
cellulitis  is  one  of  these,  because  it  originates  as  a  secondary 
result  of  septic  absorption. 

The  bacteria  or  putrefactive  germs  belong  to  Protophytes 
— the  smallest  and  simplest  of  all  plants,  some  of  them  are 
so  small  that  it  requires  the  highest  powers  of  the  micro- 
scope to  make  them  visible.  Their  growth  and  multiplica- 
tion have  been  experimentally  demonstrated  by  artificial 
cultivation,  and  this  now  constitutes  one  of  the  most  in- 
teresting studies  of  modern  pathology. 

Pasteur,  Lister,  Nsegle  and  others,  regard  the  decomposi- 
tion in  the  tissues  as  a  direct  result  of  the  vegetation  of  the 
bacteria.  "Decomposition  and  fungus  are  inseparable;  the 
one  ceases  when  the  other  is  removed.  Processes  of  this 
nature  set  up  by  bacteria  are  best  distinguished  as  fermenta- 
tions." Professor  Ziegler,  of  the  University  of  Tuebingen, 
says:  "The  healthy  organism  is  always  beset  with  a  multi- 
tude of  non-infectious  bacteria.  They  occupy  the  natural 
cavities  accessible  from  without,  and  especially  the  alimen- 
tary canal.  They  feed  on  the  substances  lying  in  their 
neighborhood,  whether  brought  into  the  body  or  secreted  by 
the  tissues.  In  so  doing  they  set  up  chemical  changes  in 
these  tissues.  While  the  organs  are  acting  normally,  these 
fungi  work  no  mischief  to  the  tissues  in  which  they  lie,  or  to 
the  system  generally.  The  products  of  decomposition  set 
up  by  such  non-specific  micro-organisms  are  either  harmless 
or  are  conveyed  out  of  the  body  before  they  begin  to  be 
active. 

"Settlements  of  this  kind  may,  however,  become  of  im- 
portance, if  the  bacteria  proceed  to  develop  to  any  unusual 
extent.  This  happens  when  the  contents  of  the  natural 
cavities  in  question  remains  unchanged  for  any  great  length 
of  time,  or  when  (as  in  catarrh)  the  normal  secretion  under- 


PELVIC    CELLULITIS    OR    PARAMETRITIS.  287 

goes  some  alteration.  The  products  of  bacterial  fermenta- 
tion may  then  accumulate  to  an  excessive  amount,  and 
products  may  be  found  which  do  not  normally  occur. 
Highly  poisonous  substances  are  formed  in  many  of  the 
bacterial  decompositions.  One  of  the  most  speedily  fatal 
diseases,  septicaemia,  is  due  to  blood-poisoning  of  the  sys- 
tem with  the  products  of  bacterial  putrefaction,  or  sepsis. 

"Putrid  or  septic  poison  may  be  absorbed  by  wounds  as 
well  as  by  mucous  surfaces.  Septicaemia,  which  has  just 
been  cited  as  an  instance  of  septic  poisoning,  is  generally 
due  to  wound  infection.  It  is  due  to  the  absorption  of  prod- 
ucts of  bacterial  decomposition  formed  in  a  wound  con- 
taminated by  bacteria. 

11  Infectious  bacteria  have  the  power  of  settling,  not  merely 
in  the  ingesta  and  secretions  or  in  dead  tissue,  but  also  in 
living  tissue.  This  happens  chiefly  in  the  mucous  mem- 
brane of  the  lungs.  The  uninjured  skin  is  protected  against 
invasion  by  the  horny  epidermis.  Many  bacteria  can  settle 
in  perfectly  healthy  mucous  membrane.  In  the  case  of 
others  we  must  imagine  that  they  do  not  find  a  proper  soil 
for  their  development,  unless  the  mucous  membrane  is  in- 
jured or  altered.  Of  course,  injury  or  alteration  of  this 
kind  may  serve  to  make  the  outer  skin  or  any  other  accessi- 
ble tissue,  the  starting-point  of  a  bacterial  invasion  (wound 
infection).  All  that  is  necessary  is  that  a  bacterium  should 
reach  a  spot  that  affords  the  conditions  for  its  development. 
If  this  occurs,  it  multiplies  and  forms  colonies  or  swarms. 
These  may,  according  to  the  species  of  the  fungus  dnd  the 
nature  of  the  soil,  remain  in  aggregation,  forming  heaps 
or  masses,  or  may  spread  through  the  tissues.  In  general 
terms  we  may  say  that  local  settlements  of  bacteria  will 
sooner  or  later  bring  about  degeneration  and  necrosis  of  the 
affected  tissue.  When  this  may  occur,  and  how  widely  it 
may  spread,  are  circumstances  depending  on  the  nature  of 
the  bacteria  and  of  the  tissue. 

"The  inflammatory  processes  set  up  by  bacterial  action 


288  HOME   TREATMENT. 

may  be  of  very  different  intensity  and  extent  in  different 
cases.  It  may  be  slight  or  transient,  or  may  be  severe  and 
issue  in  suppuration  and  an  abscess." 

The  above  quotation  is  perhaps  as  concise  and  complete 
an  explanation  as  the  space  in  this  article  will  permit,  and 
if  thoughtfully  considered,  it  will  be  the  means  of  under- 
standing what  is  to  be  said  of  the  disease  under  consideration. 

Pelvic  cellulitis  is  oftener  found  in  childbirth,  premature 
labor  and  abortion,  for  the  reason  that  it  is  a  wound  in 
fection,  and  the  female  organism  is  always  more  or  less 
wounded  under  these  circumstances.  In  confinement  the 
cervix  is  always  more  or  less  torn,  and  septic  matter  de- 
posited there  often  speedily  spreads  along  the  lymphatics 
and  veins  to  the  pelvic  cellular  tissue,  in  fact,  the  entire 
uterine  surface  forms  a  suitable  soil  for  bacterial  growth. 
The  vagina  is  also  more  or  less  injured  or  bruised  through 
parturient  efforts;  this  may  be  in  the  nature  of  a  laceration 
or  an  abrasion  of  its  mucous  surface. 

Outside  of  the  above  causes,  the  infection  may  be  of 
trumatic  origin,  the  most  common  causes  being  operative 
measures  on  the  vagina  or  womb  of  a  cutting,  scraping  or 
stitching  nature,  that  were  not  carried  out  under  strictly 
antiseptic  precautions,  guaranteeing  the  exclusion  of  septic 
germs.  Dilation  of  the  cervix  with  sponge  tents  or  with  in- 
struments or  probes  that  were  not  perfectly  cleansed,  causes 
infection  and  a  decomposition  of  the  retained  secretions, 
which,  becoming  absorbed,  leads  to  pelvic  cellulitis.  In  sur- 
gical operations  and  puerperal  conditions  in  which  infection 
has  been  positively  excluded,  by  careful  antiseptic  measures, 
pelvic  cellulitis  is  impossible. 

The  inflammation  in  this  disease  is  excited  by  the  irrita- 
ting influences  of  products  of  septic  decomposition;  these 
may  have  been  introduced  into  the  system  at  the  time  of 
confinement  or  of  an  operation,  or  they  may  have  been  in  the 
vaginal  tract  before  the  operations  were  commenced.  This 
teaches  an  important  lesson,  which  few  seem  to  have  learned; 


PELVIC    CELLULITIS    OR    PARAMETRITIS.  289 

it  is  this,  that  the  strictest  antiseptic  regulations  in  a  confine- 
ment or  operation  are  of  no  avail,  if  the  patient  herself  is  not 
first  thoroughly  disinfected  before  the  operation  begins. 

In  the  German  Empire  there  is  a  legal  provision  giving 
full  instructions  for  the  necessary  disinfection  of  the  lying-in 
woman  and  her  attendant;  if  there  were  such  a  wise  pro- 
vision in  this  country,  we  would  not  hear  of  so  many  deaths 
of  women  in  childbed,  from  blood  poisoning.  At  the  Co- 
penhagen International  Medical  Congress  (1884),  Professor 
Esmarch,  one  of  the  most  celebrated  of  German  surgeons, 
said  that  "humanity  demands  antiseptic  treatment  of 
wounds  and  wounded."  I  believe  that  the  time  will  soon 
come  that  antiseptic  regulations  in  the  treatment  of  diseases 
will  not  only  be  compulsory,  but  that  a  neglect  of  the  same, 
causing  death  by  blood  poisoning,  will  make  the  attendant 
liable  for  exemplary  damages. 

Pelvic  cellulitis  generally  develops  itself  in  an  acute 
form,  and  the  symptoms  are  very  similar  to  those  of  pelvic 
peritonitis,  and,  like  the  latter  affection,  there  is  always  an 
exudation  of  inflammatory  material  in  these  cases,  so  that 
the  meshes  of  the  tissues  become  soaked  like  a  sponge  witli 
water.  •The  invasion  of  the  infection  is  usually  signalized 
by  a  distinct  chill  or  rigors  followed  by  an  increased  bod- 
ily temperature  and  a  correspondingly  rapid  pulse.  The 
commencement  of  a  parametritis  is  not  often  without  dis- 
tinct symptoms  that  affect  the  nervous  system.  The  patient 
feels  uncomfortably  depressed,  a  tired,  worn-out  feeling  over- 
comes her,  she  loses  her  appetite,  and  there  is  pain  in  the 
pelvic  cavity.  This  pain  is  partly  due  to  an  accompanying 
peritoneal  irritation,  or  in  some  cases  to  a  circumscribed  in- 
flammation of  the  peritoneum.  Often  the  pain  runs  down 
the  groin,  along  the  course  of  the  great  vessels  and  nerves; 
this  is  occasioned  from  the  exudation  pressing  on  the  trunks 
of  these  structures  in  the  pelvis.  Pain  in  the  small  of  the 
back,  and  painful  defecation,  with  an  irritable  bladder,  are 
due  to  the  same  cause. 
19 


290  HOME    TREATMENT. 

Phlegmasia  alba  dolens,  or  what  was  called  before  the 
dawn  of  modern  pathological  science,  milk  leg,  is  only  an- 
other form  or  a  complication  of  pelvic  cellulitis.  This  oc- 
curs where  the  infectious  inflammatory  process  runs  along 
the  cellular  or  connective  tissue  of  the  large  vessels  and 
nerves,  to  the  connective  tissue  of  the  thighs ;  this  is  a  very 
easy  matter,  because  the  vessels  and  nerves  are  imbedded 
in  cellular  tissue,  and  as  the  vessels  leave  the  pelvis  at  the 
groin,  this  tissue  is  continuous  with  that  of  the  extremities. 
When  the  inflammation  gets  into  the  thighs,  it  invades 
either  the  subcutaneous  cellular  tissue,  that  is,  the  connect- 
ive tissue  under  the  skin,  or  it  runs  along  the  trunks  of  the 
nerves  and  vessels;  the  affected  limb  becomes  then  edema- 
tous or  swollen,  hence  the  vague  term  of  milk  leg,  because 
the  milk  has  never  anything  to  do  with  it.  One  time  it 
was  supposed  that  this  affection  is  only  possible  after  con- 
finement, but  this  is  an  error,  because  phlegmasia  alba  may 
develop  at  any  time  from  purulent  infection,  originating 
from  any  cause. 

The  so-called  puerperal  or  childbed  fever  is  also  nothing 
more  nor  less  than  an  infection  of  purulent  secretion. 

The  extent  of  the  exudation  varies  greatly,  both  in  the 
pelvis  and  in  the  limbs.  In  the  pelvis  it  is  sometimes  only  a 
little  swelling  on  each  side  of  the  womb,  and  between  the 
folds  of  the  broad  ligaments,  small  nodules  the  size  of  wal- 
nuts can  only  be  felt,  while  in  other  cases  the  entire  pelvic 
roof  is  covered  and  soaked  with  the  inflammatory  effusion. 
The  consistence  of  these  swellings  or  tissues  feels  at  first 
doughy  or  soft,  but  after  the  absorption  has  been  going  on 
for  a  while,  it  becomes  as  hard  as  a  board.  If  the  exudation 
begins  to  suppurate  and  an  abscess  forms,  then  the  surround- 
ing tissue  becomes  soft  again,  so  that  the  fluctuation  of  an 
elastic  tumor  becomes  recognizable. 

In  the  majority  of  cases  the  inflammatory  process  be- 
comes circumscribed  in  the  pelvis,  the  fever  subsides,  and 
the  pain  and  sensitiveness   in   the  pelvis  disappear.     The 


PELVIC    CELLULITIS    OR    PARAMETRITIS.  291 

exudation  has  also  a  circumscribed  limit,  becoming  harder 
and  smaller,  until  it  finally  has  become  entirely  absorbed. 
In  another  class  of  cases,  the  swelling  remains  stationary 
for  a  long  time  and  a  solid  tumor  remains  in  the  pelvic 
cavity,  that  may  be  mistaken  for  an  ovarian  or  fibroid 
growth,  but  in  the  course  of  a  long  time,  it  may  gradually 
become  absorbed.  In  a  certain  proportion  of  cases  the 
course  of  the  disease  becomes  protracted  or  chronic,  because 
the  effusion  is  very  slow  to  disappear.  In  these  cases  there 
is  danger  of  general  septic  infection  or  septicaemia,  and  of  a 
spreading  of  the  cellular  inflammation  to  the  general  peri- 
toneal membrane,  which  would  prove,  quite  likely,  fatal. 
If  the  inflammation  is  violent  and  the  infection  intense, 
suppuration  and  abscesses  will  destroy  the  cellular  tissue 
and  if  the  lower  extremities  become  involved,  the  circu- 
lation in  the  affected  limb  may  become  permanently  in- 
jured. The  cellular  tissue  around  the  veins,  or  even  the 
veins  themselves,  become  more  or  less  affected  by  the  in- 
flammatory process,  so  that  the  veins  become  compressed  or 
constricted  from  the  cicatrization  around  them,  or  their  cal- 
iber may  become  obliterated  from  inflammation  of  the  walls 
of  the  veins,  thus  offering  a  permanent  impediment  to  the 
return  of  the  blood  to  the  heart;  the  affected  limb  now  re- 
mains swollen,  and  the  swelling  may  entirely  subside  in  the 
recumbent  posture  at  night,  but  during  the  day  it  returns 
again,  to  make  the  leg  thick  and  clumsy. 

TREATMENT. 

Prevention  in  these  affections  is  much  better  than  cure. 
The  treatment  of  a  recent  case  of  pelvic  cellulitis  must  be 
energetically  antiseptic.  The  seat  of  the  infection  must  be 
discovered;  the  vagina  or  cavity  of  the  uterus,  as  the  case 
may  be,  must  be  thoroughly  washed  out  with  a  1  to  2,000 
corrosive  sublimate  solution.  After  a  thorough  disinfec- 
tion, the  inflammation  and  pain  can  be  checked  or  con- 
trolled by  the  application  of  ice  bags;  this  is  the  remedy 


292  HOME   TREATMENT. 

par  excellence  to  check  acute  inflammatory  processes.  These 
bags  are  preferably  of  rubber,  about  4x6  inches  in  size,  and 
when  filled  with  ice  and  before  applied  it  is  more  comfort- 
able to  the  patient  to  envelop  the  bag  in  a  thin  layer  of 
flannel,  which  takes  off  the  clammy  coldness.  The  patient 
should  be  kept  perfectly  quiet  and  the  bowels  daily  moved 
by  a  mild  purgative.  After  the  sensitiveness  and  the  fever 
have  subsided,  the  absorption  of  the  hardened  inflammatory 
remnants  is  promoted  by  the  daily  employment  of  hot  sitz 
baths  and  the  application  of  tincture  of  iodine  to  the  ingui- 
nal regions,  as  well  as  the  use  of  iodoform  suppositories. 

The  employment  of  blistering  fluids  or  plasters  is  of  no 
particular  value  either  to  check  the  inflammation  or  pro- 
mote the  absorption. 

If  there  are  symptoms  of  suppuration  forming  abscesses, 
these  should  be  freely  opened  into  the  vagina  and  their  cav- 
ities thoroughly  rinsed  out  with  a  disinfecting  solution. 

In  the  case  of  phlegmasia  do!  ens  alba  I  have  used  cold 
water  compresses  fortified  by  ice  bags  with  brilliant  results, 
but  only  after  all  the  other  treatments  that  are  laid  down 
in  different  treatises  had  been  tried,  and  failed  to  give  the 
slightest  relief.  Among  these  were  hot  fomentations,  large 
repeated  doses  of  morphine,  and  liniments  of  everything  that 
is  usually  prescribed  to  relieve  pain  ;  for  the  pain  in  phleg- 
masia is  sometimes  excruciating. 

My  experience  of  the  beneficial  effects  of  ice  bags  and 
cold-water  compresses  in  the  acute  stages  of  pelvic  cellulitis 
and  perimetritis,  led  me  to  believe  that  the  same  measures 
would  be  useful  when  the  cellulitis  was  in  the  cellular  tis- 
sue of  the  extremities,  which  constitutes  phlegmasia  dolens, 
ignorantly  termed  milk  leg.  This  appeared  to  be  heroic 
treatment  to  the  patient,  who  dreaded  the  shock  and  feared 
bad  consequences,  but  she  finally  consented. 

The  following  was  my  method :  an  ordinary  large  towel 
was  dipped  into  iced  water,  wrung  out  and  clapped  around 
the  affected  limb,  a  heavy  flannel  roller  bandage  was  then 


PELVIC    CELLULITIS    OR    PARAMETRITIS.  293 

applied  from  the  toes  upward  to  the  groin ;  flannel  is  prefer- 
able, because  it  does  not  get  hard  when  moist  and  remains 
softer  under  similar  conditions  than  cotton  material.  On 
the  most  painful  parts,  like  the  inner  aspects  of  the  thighs, 
the  back  of  the  flexure  of  the  knee,  or  popletial  region,  and 
the  calf  of  the  leg,  I  laid  rubber  bags  filled  with  ice  in  addi- 
tion to  the  cold-water  compresses;  these  were  kept  in  place 
by  a  circular  binder  independent  and  outside  of  the  roller 
bandage. 

The  patient  is  naturally  a  little  shocked  when  the  cold 
towel  is  first  applied,  but  the  unpleasantness  is  only  mo- 
mentary, and  then  the  reaction  brings  ease  and  comfort,  so 
that  she  desires  the  ice  bags  to  be  renewed  quite  often  at 
first,  for  the  patient  has  now  found  a  remedy  that  relieves 
the  pain  as  nothing  else  has  ever  done  before.  When  the 
towels  become  dry  and  hot,  the  painful  symptoms  return,  so 
that  they  should  be  dipped  four  to  six  times  in  the  twenty- 
four  hours.  If  the  sensitiveness  on  pressure  and  other  in- 
dications denote  that  the  acute  inflammatory  process  is 
checked,  then  the  compresses  and  ice  may  be  discontinued. 
This  treatment  avoids  suppuration  and  the  formation  of  ab- 
scesses, while  hot  applications  encourage  them. 

A  mild  stimulating  diet  of  milk  and  egg  punch  with  ten 
to  fifteen  grains  of  quinine  each  day  should  be  given  in  all 
infectious  inflammations. 


CHAPTER  XXV. 

ELECTRICITY  AS  A  REMEDY. 

In  a  brief  reference  to  the  medical  virtues  of  electricity 
in  the  treatment  of  diseases  of  women,  only  an  outline  of 
its  physics  can  be  given,  so  as  to  give  the  reader  an  approx- 
imate idea  of  its  origin  and  phenomena. 

The  use  that  is  being  made  of  electricity  in  the  arts  has 
convinced  everybody  that  it  is  a  most  powerful  agent,  which 
manifests  itself  in  so  many  different  phenomena  that  it  is  as 
mysterious  to-day  as  it  was  centuries  before  Christ,  when 
the  Greeks  first  observed  it  in  amber  when  rubbed  with 
silk,  and  from  which  the  term  has  been  derived. 

Electricity  is  developed  in  bodies  from  a  variety  of 
causes,  among  which  are  friction,  pressure,  chemical  action, 
heat,  and  magnetism.  We  are  acquainted  with  it  only 
through  the  peculiarity  of  its  action,  and  it  behaves  as  a  sub- 
tile, imponderable  fluid  of  a  compound  nature,  possessing 
opposite  polarity  when  excited,  giving  rise  to  positive  and 
negative  electricities,  but  when  at  rest  these  forces  seem  to 
neutralize  each  other,  and  as  such  pervade  all  matter. 

Chemical  action  is  usually  the  most  convenient  for  ob- 
taining electricity  for  medicinal  purposes,  and  the  arrange- 
ment through  which  this  is  accomplished  is  called  a  cell  or 
battery. 

A  battery  in  its  simplest  construction  is  made  of  a  plate 
of  zinc  and  a  plate  of  copper  partially  immersed  in  dilute 
sulphuric  acid.  A  disturbance  of  the  neutral  electricity 
now  ensues,  and  by  means  of  a  delicate  instrument,  it  may 
be  observed  that  the  zinc  plate  possesses  a  feeble  charge  of 
negative  and  the  copper  a  feeble  charge  of  positive  electric- 
ity; at  the  same  time  there  is  a  slight  escape  of  hydrogen 

(294) 


PLATE  V. 


.^^^f\ 


Apostoli's   method   of    employing   intense   galvanic    currents 
without   discomfort    or   injury    to    the    patient. 

The  internal  electrode,  which  he  calls  the  txcitateur  intraitteriii,  is  held  in  the  hand 
of  the  operator.    The  dispersing electrode  covers  the  abdomen. 


ELECTRICITY  AS  A  REMEDY  295 

from  the  surface  of  the  zinc.  If  now  the  plates  are  con- 
nected by  means  of  a  metallic  wire,  the  chemical  action  in- 
creases and  the  hydrogen  gas  is  now  discharged  from  the 
surface  of  the  copper.  The  wire  is  now  traversed  by  an 
electric  or  voltaic  current,  which  imparts  to  the  connecting 
wire,  thermal,  magnetic  and  other  properties. 

The  electricity  does  not,  however,  correspond  to  that 
which  was  peculiar  to  the  metallic  plates  before  they  were 
connected  by  the  wire,  but  the  opposite  electrical  conditions 
discharge  themselves  from  the  wire:  the  direction  of  the 
current  in  the  fluid,  being  from  the  positive  or  copper  plate 
to  the  zinc  or  negative  plate,  and  vice  versa,  so  that  the  wire 
of  the  zinc  plate  is  now  positive,  while  that  of  the  copper  is 
negative. 

Poles  and  electrodes.  The  wires  or  terminals  are  called 
the  poles  of  the  battery ;  instead  of  the  term  poles,  the  word 
electrode  is  now  generally  used.  From  what  was  said  of  the 
origin  and  direction  of  the  current  in  the  fluid,  it  is  impor- 
tant to  remember  that  the  positive  electrode  or  wire  is  con- 
nected to  the  negative  plate,  while  the  negative  electrode  is 
connected  with  the  positive  plate. 

According  to  the  extent  of  surface  of  both  zinc  and  cop- 
per plates,  exposed  to  the  chemical  action  of  the  diluted  sul- 
phuric acid,  or  to  the  number  of  cells  that  are  employed,  by 
connecting  the  copper  plate  of  one  cell  to  the  zinc  plate  of 
the  next,  the  force  and  quantity  of  the  electric  current  is 
correspondingly  increased. 

Batteries  which  consist  of  one  solution  and  two  metals 
rapidly  lose  their  intensity,  partly  from  the  decrease  in  the 
chemical  action  owing  to  the  neutralization  of  the  sulphuric 
acid  by  its  combination  with  the  zinc,  and  partly  from  sec- 
ondary currents,  depositing  a  layer  of  hydrogen  and  metallic 
zinc  on  the  copper  plate,  which  destroys  the  dissimilarity 
of  the  metals,  so  that  the  electrical  action  ceases  or  the 
plates  become  polarized. 

For  this  reason  these  single  fluid  batteries  have  almost 


296  HOME   TREATMENT. 

entirely  gone  out  of  use,  and  batteries  with  two  liquids  have 
taken  their  place. 

Electrolysis  means  to  dissolve  or  decompose,  by  means 
of  electricity,  an  organic  or  inorganic  substance  into  its 
original  elements.  If,  for  instance,  a  current  of  electricity 
of  four  or  five  Bunsen's  cells  is  conducted  to  two  inverted 
glass  tubes,  filled  with  water  slightly  acidulated  to  increase 
its  conductivity,  gas  bubbles  rise  from  the  surface  of  each 
pole,  and  upon  examination  it  is  found  that  hydrogen  is 
liberated  at  the  negative  pole  and  oxygen  at  the  positive 
pole;  and  as  the  volume  of  hydrogen  liberated  is  about 
twice  that  of  oxygen,  the  experiment  gives  at  once  the  qual- 
itative and  quantitative  analysis  of  water. 

Professor  Bartholow,  in  his  treatise  on  Medical  Electricity 
says:  "As  animal  tissues  are  composed  of  substances  amen- 
able to  electrolytic  decomposition,  it  is  obvious  that  they 
must  yield  up  their  component  elements  in  accordance  with 
the  laws  of  electrolysis.  Albumen  is  coagulated,  salts  are 
separated  into  acids  and  bases,  and  water  is  resolved  into 
oxygen  and  hydrogen.  When  the  salts  contained  in  the 
animal  tissues — soda,  potassa,  lime — and  water,  are  decom- 
posed, the  acids  and  oxygen  appear  at  the  positive  pole, 
and  the  alkalies  and  hydrogen  at  the  negative.  It  follows 
that  if  the  positive  electrode  be  composed  of  metal,  it  will 
be  corroded  by  the  action  of  chlorine  and  the  acids,  and  the 
negative  will  remain  unacted  on  and  smooth.  The  tissues 
in  the  vicinity  of  each  electrode  are  necessarily  affected  by 
the  elements  brought  to  them  in  accordance  with  chemical 
laws.  About  the  positive  the  mineral  acids  and  chlorine 
form  combinations,  and  hence  do  not  attack  the  tissues  with 
the  same  energy  as  those  about  the  negative  pole.  If,  how- 
ever, the  positive  electrode  is  composed  of  zinc,  for  example, 
the  chlorine  attacking  it  will  form  chloride  of  zinc,  a  very 
corrosive  material.  This  principle  has  been  utilized  to  pro- 
duce caustic  effects  at  the  positive  pole.  Although  the  neg- 
ative electrode  remains  smooth,  much  more  than  at  the  pos- 


ELECTRICITY  AS  A  REMEDY.  297 

itive  are  seen  these  destructive  effects  from  the  action  of  the 
free  alkali  liberated  in  its  neighborhood.  When  an  ordi- 
nary electrode  of  carbon  covered  with  soft  sponge  is  made 
to  conduct  a  strong  galvanic  current,  the  skin  speedily  be- 
comes reddened,  and  may  be  made  to  ulcerate  if  the  contact 
is  sufficiently  prolonged.  If  the  carbon  is  applied  directly, 
an  intense  burning  is  produced  and  the  tissues  are  destroyed, 
leaving  a  slough,  which  is  slowly  detached  and  the  ulcer  re- 
maining is  difficult  to  heal.  The  caustic  action  is  due 
chiefly  to  the  soda,  potash,  and  lime.  Some  effect  must  also 
be  allowed  to  the  disassociation  of  the  tissues,  to  their  trans- 
ference from  point  to  point  and  at  the  negative  pole  to  the 
mechanical  action  of  the  liberated  hydrogen." 

Interpolar  regions.  The  reader  must  have  been  im- 
pressed with  the  peculiarity  of  each  pole  in  possessing  affin- 
ity or  attraction  for  certain  elements  that  constitute  the 
animal  tissue.  Oxygen  and  acids  accumulate  around  the 
positive  pole,  while  alkalies  are  attracted  to  the  negative 
pole ;  thus  it  must  be  an  absolute  fact  that  an  actual  trans- 
fer of  particles  in  both  directions  to  each  j>ole  must  traverse 
the  tissue  lying  between  the  two  poles ;  this  accounts  in  a 
great  measure  for  the  difference  of  the  local  effect  on  the 
tissues  around  the  poles,  one  being  in  the  nature  of  an  acid 
the  other  of  a  caustic  alkali.  This  naturally  gave  rise  to  an 
inquiry  as  to  the  effect  that  the  galvanic  current  has  on  the 
structure  between  the  two  poles. 

Dr.  G.  Betton  Massey,  author  of  "  Electricity  in  the  Dis- 
eases of  Women,"  asks  and  answers  this  question  in  the  fol- 
lowing manner:  "  What  can  be  therapeutically  accomplished 
when  the  seat  of  the  disease  is  necessarily  situated  beyond 
the  direct  reach  of  the  electrode  ?  An  answer  drawn  from 
both  neurological  and  gynecological  experience  is  that  much 
can  be  accomplished ;  and  this  is  doubtless  due,  in  the  first 
place,  to  the  influence  upon  nutrition  of  the  chemical 
changes  that  occur  throughout  the  circuit,  in  the  onward 
progress  of  the  particles  that  appear  free  finally  at  the  poles 


298  HOME    TREATMENT. 

to  the  influence  upon  nutrition  of  the  circulatory  changes 
that  result  from  vasomotor  stimulation,  and  to  the  contrac- 
tions produced  in  unstriated  muscular  tissue  by  heavy  cur- 
rents even  at  a  distance.  These  results  of  quiet  current 
transmission  are  governed  in  magnitude  at  a  given  spot 
by  the  density  of  the  current  at  the  situation  and  by  the  du- 
ration of  the  application.  To  accomplish  much  in  the  more 
distant  parts  of  this  region  considerable  strength  must  be 
employed,  hence  a  delicate  judgment  is  demanded  in  the  se- 
lection of  the  size  of  the  active  pole  to  avoid  cauterization 
on  the  one  hand,  and  too  great  a  diffusion  on  the  other." 

To  within  a  comparatively  recent  period,  the  methods 
of  applying  the  electric  current  for  the  removal  of  abnormal 
growths  have  been  somewhat  crude  if  not  dangerous.  It 
appears  that  formerly  altogether  too  much  stress  or  weight 
was  laid  on  the  chemical  or  electrolytic  effects  that  the  elec- 
trodes wrought  in  the  tissues,  and  very  little  or  no  credit 
was  given  to  the  passive  current  of  galvanism  as  it  traversed 
the  tissues  from  pole  to  pole.  Dr.  Ephraim  Cutter,  of  New 
York,  advocated  the  so-called  electro-puncture,  and  in  the 
galvanic  treatment  of  fibroid  tumors  of  the  uterus,  these 
punctures  were  made  through  the  abdominal  walls.  The 
electrodes  for  this  purpose  were  stiletto  shaped,  with  blades 
five  inches  long  and  three-eighths  of  an  inch  at  their  widest 
part;  these  were  inserted  into  the  tumor  from  opposite  points. 
Wounds  that  were  thus  inflicted,  necessarily  involved  more 
or  less  danger,  and,  although  Dr.  Cutter  reported  a  great 
number  of  cures,  the  percentage  of  mishaps  was  too  great  to 
make  electrical  treatment  popular  among  the  profession. 

It  was  not  until  Apostoli,  a  French  physician,  greatly 
modified  the  methods  of  employing  electricity  in  the  treat- 
ment of  fibroid  tumors,  and  sheared  it  in  a  great  measure, 
not  only  of  its  dangers,  but  also  of  pain,  that  the  medical 
profession  took  the  question  of  electrical  treatment  in  real 
earnest.  The  practice  of  Apostoli  and  his  results  were  pub- 
lished in  a  monograph  by  Carlet,   entitled,  Du  traitement 


ELECTRICITY  AS  A  REMEDY.  299 

electrique  des  tumeurs  fibreuses  de  V uterus,  Paris,  188%.  Apos- 
toli  evidently  started  out  with  a  view  to  modify  the  most 
objectionable  features  of  the  electrical  treatment.  This  con- 
sisted in  reducing  the  number  and  size  of  the  punctures 
and  to  lessen  the  painful  sensation  of  the  electric  current  to 
its  minimum,  so  that  the  main  points  of  difference  are  the 
shape  and  size  of  electrodes,  and  the  site  that  is  chosen  fur 
the  puncture.  In  the  first  place  he  uses  only  one  piercing 
or  needle  electrode,  which  is  much  smaller  than  that  of 
Cutter,  this  may  be  attached  to  either  the  positive  or  nega- 
tive cord  of  the  battery,  according  to  the  accompanying 
symptoms.  When  hemorrhage  is  a  symptom,  the  positive 
pole  is  used  internally  or  carries  the  needle  on  account  of 
its  anti-hemorrhagic  property,  otherwise  the  negative  pole 
carries  the  piercing  electrode.  This  electrode  is  always 
used  internally  to  puncture  through  the  vagina  or  through 
the  cervical  tissue  into  the  tumor;  this  is  not  nearly  so 
painful  as  piercing  the  abdominal  walls,  nor  does  it  wound 
the  peritoneum. 

The  other  electrode  is  called  the  dispersing  electrode,  be- 
cause its  purpose  is  to  so  disperse  or  scatter  the  current  of 
this  pole  that  it  is  hardly  felt  by  the  patient,  much  less 
produces  any  electrolytic  or  chemical  etfect  on  the  skin. 
This  electrode  is  made  from  a  sheet  of  lead  or  copper  nine 
by  ten  inches  and  covered  with  a  layer  of  wet  absorbent  cot- 
ton; it  is  applied  over  the  abdomen.  This  method  is  much 
safer  than  that  formerly  advocated  by  Dr.  Cutter,  and  the 
results  are  much  better.  Dr.  Engelman,  who  has  accepted 
this  method,  says:  "  In  electrolysis  an  intensity  of  50  to  250 
milliamperes  may  be  used  for  from  three  to  eight  minutes. 
All  possible  precautions  must  be  taken  in  the  first  sitting  in 
order  to  discover  any  idiosyncrasy  of  the  patient,  and  a  cur- 
rent of  50  milliamperes  will  suffice,  attained  by  slow  in- 
crease. The  patient  should  lie  down  quietly  for  several 
hours  after  the  application.  If  an  intensity  as  high  as  100 
milliamperes  is  used  at  the  first  sitting,  it  is  preferable  that 


300  HOME    TREATMENT. 

she  remain  in  bed  for  the  first  twenty-four  hours,  and  that  a 
cold  compress  or  an  ice  bag  be  placed  upon  the  abdomen, 
to  overcome  any  tendency  to  inflammatory  reaction  which 
may  occur;  hence  the  attention  to  details  which  is  necessary, 
and  the  precautions  desirable  in  a  first  puncture,  until  the 
sufferance  of  the  individual  patient  is  tested.  The  applica- 
tion is  repeated,  according  to  the  demands  of  the  case  and 
the  severity  of  the  treatment,  once  or  twice  a  week." 

The  milliampere  meter  is  a  galvanometer  to  measure  the 
quantity  of  electricity  that  is  applied,  and  as  a  chemical  bat- 
tery will  of  necessity  change,  a  meter  is  the  only  means  of 
judging  the  intensity  of  the  current ;  so  that  without  one 
there  is  danger  of  applying  the  current  too  strong,  or  an  in- 
justice may  be  done  to  the  patient,  and  reproach  cast  on  the 
treatment  by  not  using  it  strong  enough. 

At  the  annual  meeting  of  the  American  Medical  Associ- 
ation, at  Chicago,  in  1887,  Dr.  Martin  read  a  paper,  in  which 
he  reported  three  cases  that  were  treated  with  the  most  satis- 
factory results  without  puncture.  The  positive  or  external 
electrode  was  applied  over  the  abdomen  after  the  manner  of 
Apostoli,  and  the  negative  electrode  was  placed  in  the  rec- 
tum, vagina  or  uterus,  in  such  a  way  as  to  cause  the  cur- 
rent to  traverse  the  largest  diameter  of  the  tumor;  this 
method  is  to  my  mind  the  ideal  of  an  electrical  treatment, 
it  is  galvanism  without  corrosion  or  electrolysis. 

The  number  of  eminent  authorities  that  I  have  quoted, 
can  hardly  fail  to  convince  the  reader  that  electrical  thera- 
peutics in  the  treatment  of  fibroid  tumors  are  not  only  effi- 
cacious, but  in  the  infancy  of  experimental  growth,  so  that 
every  day  will  add  new  proofs  and  improved  methods  to  the 
history  of  this  most  interesting  subject.  But  this  treatment 
is  not  limited  in  its  usefulness  to  the  removal  of  abnormal 
growths,  for  it  has  proven  itself  equally  as  effectual  in  the 
treatment  of  chronic  inflammatory  conditions  of  the  pelvic 
organs.  I  have  myself  attained  great  success  in  curing 
certain   forms  of   these   diseases   since   the    publication   of 


ELECTRICITY    AS    A    REMEDY.  301 

"A  New  Treatment  of  Chronic  Metritis,"  by  the  same  inde- 
fatigable author,  Georges  Apostoli,  of  Paris. 

The  value  of  electricity  is  now  so  firmly  established  that 
a  physician  who,  ignorant  of  its  virtues,  and  laboring  under 
this  self-imposed  ignorance,  brushes  aside  any  reference  to 
or  desire  for  electrical  treatment  with  a  supercilious  air, 
claiming  "that  there  is  nothing  in  it,"  advertises  himself  as 
incompetent  or  insincere. 

It  must  be  apparent  to  anyone  who  has  followed  this 
brief  outline  from  the  beginning,  that  this  subject  requires 
a  special  and  individual  devotion,  so  as  to  become  familiar 
not  only  with  the  elementary  principles  of  the  physics  of 
electricity,  but  with  the  technique  of  applying  the  treatment 
in  each  individual  case.  This,  few  persons  have  the  honesty 
or  ambition  to  acquire,  and  if  they  own  a  battery,  it  is  more 
for  show  than  for  use.  I  am  convinced  that  there  are  great 
possibilities  in  store  for  the  curative  value  of  the  galvanic 
current,  but  it  also  requires  a  high  order  of  intelligence  to 
employ  it,  in  order  that  those  hopes  may  be  realized. 

"The  positive  pole  is  anodyne,  sedative,  anti-congestive, 
and  anti-hemorrhagic.  It  combats  and  prevents  the  ten- 
dency to  excessive  vascularization,  and  consequently  relieves 
congestion  and  inflammation  and  the  pain  depending  upon 
these  conditions.  Its  local  or  polar  action,  when  used  within 
the  uterus,  is  hemostatic  or  styptic,  and  caustic,  with  high 
intensities  of  current. 

"  The  negative  pole  is  stimulating  and  has  a  marked  electro- 
lytic action.  It  tends  to  produce  congestion,  and  a  deriva- 
tive effect  which  favors  absorption  of  tumors,  inflammatory 
deposits  and  adhesions.  But  great  care  must  be  observed  in 
using  it  in  some  conditions,  lest  a  new  inflammation  be  re- 
kindled." 

I  have  the  record  of  a  case  where  the  womb  was  re- 
troflexed  and  tied  down  by  old  inflammatory  adhesions  for 
nine  years;  the  retroflexion  dated  back  to  a  miscarriage. 
This  woman  had  been  aninvalid  since  that  time;  her  appe- 


302  HOME    TREATMENT. 

tite  was  poor,  and  her  digestion  poorer,  she  was  excessively 
constipated,  suffered  from  pain  during  menstruation,  but  at 
other  times  there  was  a  constant  pain  in  the  small  of  her 
hack,  which  ran  down  the  right  thigh,  the  bladder  was  irri- 
table, and  there  were  neuralgic  pains  shooting  from  the 
ovaries  down  the  groins.  All  these  symptoms  became  more 
or  less  aggravated  every  few  weeks  or  months.  The  womb 
was  so  firmly  fixed  or  glued  down  on  the  lower  portion  of 
the  spine,  that  it  could  not  be  moved  an  iota.  This  woman 
had  tried  all  the  remedies  that  I  could  suggest,  except  gal- 
vanism. This  I  concluded  to  try,  by  placing  a  large  dis- 
persing electrode  on  the  small  of  her  back,  and  the  other 
electrode,  properly  prepared,  so  that  it  did  not  burn  or  cau- 
terize, was  introduced  into  the  vagina,  against  the  posterior 
aspect  of  the  uterus.  A  current  strength  of  from  90  to 
120  milliamperes  was  applied  every  other  day  for  ten  min- 
utes; in  six  weeks  the  organ  was  quite  movable,  and  in  five 
months  all  adhesions  had  melted  away,  and  the  womb  occu- 
pied its  normal  position,  and  the  patient  was  in  every  way 
restored  to  health. 

The  diseases  that  are  curable  by  galvanism  are  the  differ- 
ent forms  of  subacute  or  chronic  inflammation  of  the  ovaries, 
and  the  consequent  enlargement  of  these  organs,  small  cysts 
or  fibro-cysts  of  the  ovaries  are  also  amenable  to  the  gal- 
vanic puncture. 

Catarrhal  inflammation  of  the  Fallopian  tubes,  or  when 
either  or  both  ends  are  agglutinated  with  inflammatory  exu- 
dation, so  as  to  pen  up  their  contents,  which  may  be  mucous, 
water,  pus  or  blood,  these  fluids  should  be  first  aspirated  or 
drawn  off,  and  then,  by  means  of  appropriate  galvanism,  the 
normal  conditions  of  the  tubes  may  be  restored. 

Chronic  catarrhs  of  the  womb  are  especially  suited  for 
galvanic  treatment,  and  when  the  inflammation  invades  the 
muscular  structure  of  the  uterus,  giving  rise  to  what  was 
described  as  chronic  metritis,  there  is  no  remedy  that  wrill 
yield  the  same  positive  and  satisfactory  result  as  electricity. 


ELECTRICITY    AS    A    REMEDY.  303 

Plate  V  gives  a  practical  illustration  of  the  employment 
of  electricity  for  chronic  inflammation  of  the  uterus;  the  in- 
ternal or  negative  pole  is  introduced  into  the  uterine  cavity 
and  held  there  by  the  operator,  the  external  or  dispersing 
pole  spreads  over  and  rests  on  the  abdomen. 

Sub-involution  of  the  uterus.  I  have  already  referred 
to  this  affection  as  an  arrested  involution  of  the  womb  after 
confinement  at  the  end  of  the  natural  term,  and  after  abor- 
tion. The  womb  in  this  condition  remains  permanently  and 
preternaturally  enlarged,  and  its  entire  tissue  becomes  the 
seat  of  a  subacute  or  chronic  inflammatory  process.  The 
vagina  is  also  more  or  less  relaxed,  so  that  the  heavy  uterus 
sinks  down  into  the  pelvis,  imparting  to  the  patient  a  drag- 
ging or  bearing-down  sensation,  which  makes  walking  or 
any  other  exertion  exceedingly  difficult.  In  subinvolution 
an  extra  uterine  electrode  is  not  required,  but  only  a  vaginal 
electrode,  so  employed  that  a  current  of  high  intensity  is 
passed  through  the  uterus ;  this  varies  from  50  to  150  milli- 
amperes.  The  duration  of  each  galvanization  is  from  eight 
to  ten  minutes,  and  should  be  repeated  every  third  or  sixth 
day.  I  succeed  as  a  rule  in  six  to  eight  weeks  in  restoring 
the  organ  to  its  normal  size,  which  I  ascertain  through  com- 
parative measurement  at  the  beginning  and  end  of  the 
treatment. 

If  the  subinvolution  is  complicated  with  retroflexion,  then 
intra-uterine  galvanization  after  the  organ  is  replaced  is 
the  most  effective  treatment.  Old  pelvic  adhesions  and  ex- 
udations as  a  result  of  pelvic  cellulitis  or  peritonitis  are 
amenable  to  galvanization  after  hot  douches,  sitz  baths,  and 
other  discussives  have  failed  to  excite  absorption. 

Hemorrhoids  and  prolapse  of  the  rectum ;  the  former  is 
a  frequent  concomitant  of  constipation,  and  the  latter  may 
be  the  result  of  an  imperfect  involution  after  confinement. 
I  have  employed  galvanism  for  either  with  the  most  bril- 
liant results. 

It  would  be  interesting  for  the  reader  were  I  to  continue 


304  HOME   TREATMENT. 

to  cite  different  diseases  in  which  electricity  has  been  suc- 
cessfully employed,  but  that  would  require  a  systematic 
arrangement  of  the  subject,  which  would  be  incompatible 
with  the  original  purpose  of  this  book.  I  simply  desire  to 
awaken  an  interest  in  a  comparatively  new  remedial  agent, 
in  its  present  field  of  employment.  There  may  be  a  great 
many  ways  to  get  relief,  but  that  course  which  offers  the 
least  risk  to  life  and  the  least  suffering  to  the  living  is  the 
one  that  should  recommend  itself  to  the  sufferer.  What 
patients  need  is  not  brilliant  surgical  exploits  to  make  the 
reputation  of  an  ambitious  operator,  but  the  conscientious 
aid  of  the  conservative  physician  who  is  content  to  labor  in 
the  less  pretentious  capacity  of  an  assistant  to  nature's  cura- 
tive energy. 


CHAPTER   XXVI. 

SIGNS  AND  SYMPTOMS  OF  PREGNANCY. 

Pregnancy  is  the  condition  in  which  the  female  has 
within  her  an  impregnated,  fecundated  germ,  which  gradually 
becomes  developed  in  or  out  of  the  womb.  In  a  perfectly- 
normal  state  of  things,  the  impregnated  ovum  becomes 
attached  to  the  inner  surface  of  the  womb  by  virtue  of  a 
preordained  vital  force  by  which  the  ovum  becomes  animated 
at  the  moment  of  conception.  It  obtains  its  nutrition  from 
a  plexus  of  blood  vessels,  by  means  of  which  the  ovum  is 
attached  to  the  inner  side  of  the  walls  of  the  uterus,  and 
this  complex  of  vessels  grows  with  the  development  of  the 
fetus,  and  constitutes  the  placenta,  which,  together  with  the 
membranes  and  the  umbilical  cord,  is  called  the  afterbirth. 

The  growth  of  the  embryo,  which  is  the  predestined 
child  in  the  mother's  womb,  occupies  a  period  of  ten  lunar 
months,  or  two  hundred  and  eighty  days — this  is  the  aver- 
age term  of  pregnancy,  although  the  duration  of  pregnancy 
is  prolonged  in  a  large  proportion  of  cases  to  three  hundred 
days,  and  even  longer,  while  in  a  small  proportion  of  preg- 
nant women  the  period  of  gestation  falls  naturally  shorter 
than  two  hundred  and  eighty  days. 

In  a  small  number  of  pregnancies  the  impregnated  ovum 
is  arrested  at  the  ovary,  or  on  its  passage  from  the  latter 
through  the  Fallopian  tubes;  it  then  does  not  arrive  in  the 
cavity  of  the  uterus.  This  state  of  things  is  unnatural, 
hence  termed  'preternatural,  because  the  growth  of  the  fetus 
takes  place  out  of  the  uterus,  and  this  is  also  called  extrauter- 
ine pregnancy,  which  may  take  place  in  the  ovary,  Fallopian 
20  (305) 


306  HOME   TREATMENT. 

tubes,  or  cavity  of  the  abdomen.  False  pregnancy  implies 
that  there  was  no  pregnancy  at  all,  or  in  other  words,  that 
there  was  no  fetus,  and  that  the  enlargement  was  due  to 
something  else. 

In  pregnancy  the  female  experiences  signs  and  symp- 
toms resulting  from  changes  in  the  condition  of  her  organs 
and  functions.  The  suppression  of  the  courses  or  menstrual 
discharges  is  considered  in  the  popular  mind  an  unerring 
proof  of  pregnancy,  yet,  as  a  matter  of  fact,  this  is  far  from 
the  truth.  I  have  known  of  two  women  who  menstruated 
regularly  during  the  entire  period  of  their  pregnancies,  and 
there  are  a  number  of  reliable  cases  recorded  of  women  who 
menstruated  during  pregnancy  and  at  no  other  time. 

It  is  a  rule,  that  the  menses  cease  during  pregnancy,  but 
it  is  equally  certain  that  the  menstrual  function  becomes 
suspended  from  other  causes,  and  these  are  quite  numerous, 
so  that  taken  by  itself,  the  sign  is  of  little  importance. 
Young  married  women  not  infrequently  have  a  slight  men- 
struation for  two  or  three  periods  after  their  first  conception, 
and  on  the  other  hand,  newly  married  women  will  have  their 
menses  occasionally  arrested,  and  this  may  continue  for  two 
or  three  months  and  indeed  no  pregnancy  exist. 

Nausea  and  vomiting  is  also  presumptive  evidence  of 
gestation.  Some  women  are  affected  with  sick  stomach 
almost  from  the  moment  of  conception,  and  from  actual 
experience  they  are  so  certain  of  their  condition,  that  they 
can  calculate  with  certainty  the  day  of  their  confinement 
from  the  time  when  they  had  their  first  feeling  of  nausea. 
Experience  seems  to  teach  that  a  certain  amount  of  nausea, 
the  'morning  sickness,  and  the  vomiting  which  accompanies  or 
follows  it,  is  to  be  met  in  women  who  go  through  a  natural 
or  healthy  pregnancy,  so  that  many  eminent  authorities 
have  looked  upon  this  symptom  as  a  physiological  accompa- 
niment, and  one  of  the  most  constant  and  reliable  symptoms. 
The  vomiting  and  nausea  of  pregnancy  is  different  from  that 
which  is  an  indication  of  general  ill  health;  in  pregnancy 


SIGNS    AND   SYMPTOMS  OF   PREGNANCY.  307 

the  vomiting  is  followed  with  a  sense  of  relief,  and  the 
patient  is  for  the  time  being  quite  easy.  The  length  of  time 
that  women  feel  this  gastric  irritability  varies  in  different 
individuals;  ordinarily  it  will  cease  about  the  fourth  month, 
sometimes  sooner,  and  it  may  return  again  during  the  last 
two  or  three  months  of  gestation.  It  is  supposed  to  be  due 
to  a  reflex  action  of  the  spinal  cord  from  the  uterus  to  the 
stomach.  It  must  be  remembered,  however,  that  a  disease 
of  the  uterus,  a  fibroid  or  ovarian  tumor,  and  a  suppression 
of  the  menses  from  other  causes  than  pregnancy  will  occasion 
nausea  and  vomiting. 

A  capricious  appetite  is  another  of  the  peculiarities  of 
pregnancy,  a  longing  for  unnatural  food,  so  that  some 
women  will  enjoy  eating  such  things  as  chalk,  slate  pencils,  and 
similarindigestible  stuff;  this  I  have  always  considered  a  form 
of  hysteria,  that  is,  a  functional  derangement  of  the  nervous 
system,  for  which  I  gave  ten  grains  of  bromide  of  sodium 
three  times  a  day,  with  the  best  results;  others  again  became 
passionately  fond  of  sour  salads,  or  strong  condiments  like 
mustard,  Worcestershire  sauce,  and  salt  fish,  while  others 
again  long  for  fruits. 

Salivation  of  the  mouth  is  another  very  unpleasant 
symptom  which  annoys  some  women  when  they  are  preg- 
nant, for  they  will  secrete  such  enormous  quantities  of  saliva, 
that  they  cannot  help  drooling  from  the  mouth  when  they 
speak.  In  salivation  of  pregnancy  the  gums  do  not  become 
sore  as  in  the  salivation  from  mercury;  in  the  former  the 
irritation  is  confined  to  the  salivary  glands  alone.  The 
wonderful  sympathy  that  exists  between  remotety  situated 
organs  of  the  body  is  here  strikingly  illustrated  between  the 
sexual  organs  and  the  salivary  glands  in  both  sexes.  In 
mumps  also,  which  is  an  inflammation  of  the  salivary  gland, 
it  is  not  unusual  for  the  testes  in  the  male  and  the  mammae 
in  the  female  to  become  swollen  and  painful,  and  as  soon  as 
this  swelling  takes  place,  the  inflammation  of  the  salivary 
gland  disappears. 


308  HOME   TREATMENT. 

The  breasts  become  enlarged  and  otherwise  altered  in 
pregnancy,  the  enlargement  is  accompanied  with  more  or 
less  sharply  shooting  pain,  they  also  become  harder  and  are 
more  movable  than  otherwise.  The  nipple  becomes  more 
prominent  and  painfully  sensitive,  the  veins  that  run  from 
the  breast  become  distended  so  that  they  can  be  readily 
traced  by  the  eye.  The  presence  of  milk  in  the  mammse  is 
another  sign,  but  that,  too,  is  only  presumptive,  because  the 
secretion  of  milk  takes  place  in  other  conditions  than  that 
of  pregnancy;  even  the  newly-born  infant  has  sometimes 
milk  in  its  breasts,  and  milk  has  been  recognized  in  the 
breasts  of  some  males  and  not  infrequently  in  those  of  young 
virgins. 

Pigmentation  or  the  deposit  of  coloring  matter  in  preg- 
nancy has  long  been  observed  as  a  prominent  symptom  and 
when  taken  together  with  other  signs  it  is  worthy  of  careful 
consideration,  but  here,  too,  we  encounter  the  obstacle  to  amT- 
thing  of  a  positive  nature,  for  discoloration  is  also  met  with 
in  females  who  are  suffering  from  pelvic  diseases  and  who 
are  not  pregnant.  Areola  is  the  technical  name  of  that 
peculiar  circle  which  immediately  surrounds  the  nipple. 
In  a  healthy  virgin  this  circle  is  characterized  by  a  beautiful 
rose-tinted  blush,  but  under  the  influence  of  disease,  even  in 
the  virgin  the  circle  becomes  more  or  less  discolored.  When 
pregnancy  has  occurred  the  areola  around  the  nipple  becomes 
darker  and  darker;  other  parts  of  the  body  become  similarly 
discolored,  this  occurs  on  the  abdomen  and  perineum. 

The  womb  descends  during  the  first  two  months  of  preg- 
nancy, this  constitutes  a  kind  of  physiological  falling  of  the 
womb  and  indeed  the  accompanying  symptoms  of  a  preg- 
nant woman  are  often  similar  or  identical  to  that  diseased 
and  permanent  condition  of  physical  suffering,  namely,  fall- 
ing of  the  womb.  Perhaps  the  most  common  symptoms  of 
the  descent  of  the  uterus  will  be  more  or  less  frequent  desire 
to  pass  water,  because  of  the  dragging  of  the  womb  on  the 
neck  of  the  bladder;  sometimes  there  is  also  a  straining  or 


SIGNS    AND   SYMPTOMS   OF    PREGNANCY.  309 

inclination  to  go  to  stool,  owing  to  pressure  on  the  rectum 
from  the  same  cause. 

The  umbilicus  or  navel  becomes  painful  and  even  de- 
pressed from  traction  of  the  superior  ligament  of  the  bladder, 
which  is  attached  to  the  umbilicus,  thus  illustrating  the 
operation  of  cause  and  effect,  namely,  as  the  bladder  is  de- 
pressed by  the  descended  uterus,  the  bladder  in  turn  pulls 
on  the  umbilicus  to  which  its  ligament  is  attached.  The 
pregnant  uterus  remains  only  the  first  few  months  in  this 
depressed  state;  at  the  third  month,  as  a  result  of  its  continual 
growth  and  that  of  the  fetus,  the  uterus  ascends  out  of  the 
pelvis  and  as  a  natural  consequence  the  symptoms  of  the 
bladder  and  rectum  subside.  Towards  the  end  of  the  ninth 
month  the  womb  again  descends  into  the  pelvis  and  with 
this  there  may  be  a  return  of  the  irritation  of  the  bladder 
and  a  feeling  of  bearing  down  or  tenesmus  of  the  rectum. 
The  descent  of  the  uterus  toward  the  close  of  pregnancy 
diminishes  the  prominence  of  the  abdomen,  and  as  the 
diaphragm  has  freer  play,  the  respiration  becomes  easier;  if 
there  was  any  cough  that,  too,  disappears,  and  on  the  whole 
the  woman  feels  herself  more  comfortable  and  in  happy 
spirits.  This  may  even  arouse  suspicion  in  her  own  mind 
as  to  her  condition,  because  she  does  not  know  the  cause  of 
the  change;  it  may  portend  to  her  that  something  is  not 
right,  that  she  is  not  pregnant  or  that  her  child  may  be 
dead.  In  women  who  have  borne  one  or  more  children  in 
a  natural  manner,  the  descent  of  the  womb  is  of  no  particu- 
lar moment  in  the  last  months  of  gestation,  because  the 
abdominal  walls  having  been  stretched  by  previous  preg- 
nancies the  body  or  fundus  of  the  womb  may  fall  forward 
and  give  the  lungs  and  other  organs  relief  from  pressure, 
but  in  the  first  pregnancy  this  is  never  the  case,  because  the 
abdominal  walls  are  too  tense  to  allow  this  normal  ante- 
version. 

The  German  school  of  midwifery  has  laid  down  an  im- 
portant rule  as  a  consequence  of  this  observation,  and  I  have 


310  -  HOME    TREATMENT. 

never  known  an  exception  to  occur  in  my  experience.  The 
rule  is  that  when  the  uterus  does  not  descend  into  the  pelvis 
toward  the  close  of  the  first  pregnancy,  it  is  because  there  is 
a  disproportion  between  the  child's  head  and  the  maternal 
pelvis,  or  in  other  words  that  either  the  child's  head  is  too 
large  for  a  natural  or  unaided  delivery  to  take  place,  or  that 
the  pelvis  of  the  mother  is  too  small  for  a  natural  delivery 
to  take  place,  and  this  is  true,  and  knowing  this  to  be  true 
at  the  outset  or  commencement  of  a  confinement  it  would 
be  only  torture  and  a  valuable  loss  of  time  to  wait  at  the 
bedside  of  a  woman  suffering  with  the  pangs  of  childbirth 
in  the  vain  hope  that  she  might  deliver  herself — when  in 
truth  and  as  a  fact  that  cannot  be'  done  without  the  aid  of 
scientific  assistance. 

The  vagina  and  external  organs  are  more  or  less  modi- 
fied in  pregnancy.  The  vagina  becomes  wider  and  shorter 
and  as  there  is  an  increase  of  spongy  tissue,  it  presents  a 
swollen  appearance.  The  mucous  glands  become  larger  and 
secrete  a  greater  abundance  of  mucus.  The  internal  surface 
of  the  vagina  becomes  discolored  in  consequence  of  preg- 
nancy and  I  believe  that  it  is  one  of  the  most  reliable  pre- 
sumptive signs;  the  mucous  membrane  presents  a  sort  of 
bluish  tint,  a  French  authority  calls  it  a  violet  hue,  not 
unlike  the  lees  of  wine. 

Quickening  is  a  term  that  is  employed  to  designate  the 
particular  length  of  time  that  pregnancy  has  existed,  and  at 
the  same  time  to  furnish  evidence  to  the  mother  through  the 
movements  of  the  fetus  that  she  carries  within  her  womb  a 
living  being.  In  a  former  chapter  I  have  already  detailed 
the  theory  of  the  ancients  upon  this  subject,  which  was  as 
absurd  as  it  was  fanciful.  The  late  Professor  Bedford  defines 
"quickening  as  nothing  more  than  the  ordinary  result  of 
progressive  increase  when  the  physical  organization  of  the 
fetus  has  reached  a  state  of  development  which  imbues  it 
with  the  power  of  movement — a  movement  dependent  upon 
muscular  contraction."     The  period  of  quickening  is  usually 


SIGNS   AND   SYMPTOMS   OF    PREGNANCY.  311 

about  the  fourth  and  a  half  month  or  the  middle  term  of 
pregnancy. 

Pulsation  of  the  fetal  heart,  when  heard,  is  no  longer 
presumptive  but  absolutely  positive  evidence  that  pregnancy 
exists.  That  the  heart  of  the  child  can  be  distinctly  heard 
to  beat  in  its  mother's  womb  was  one  of  the  greatest  discov- 
eries in  midwifer}r.  The  pulsations  of  the  fetal  heart  are 
much  faster  than  those  of  the  mother's  heart,  hence  there  is 
no  danger  of  getting  them  mixed;  while  the  child's  heart 
averages  from  one  hundred  and  ten  to  one  hundred  and 
sixty  per  minute,  the  heart  of  the  mother  averages  from 
seventy-five  to  eighty  beats.  There  are  cases  where  the 
mystery  of  a  pregnancy  can  be  solved  beyond  a  possibility 
of  a  doubt,  through  the  recognition  of  the  pulsations  of  the 
fetal  heart,  and  yet  a  woman  may  be  pregnant  in  whom  it 
will  be  impossible  to  distinguish  the  action  of  the  child's 
heart,  at  the  termination  of  her  period  of  gestation  she  will 
bring  forth  a  healthy  child. 

The  question  whether  a  female  is  pregnant  will,  from  the 
very  nature  of  the  symptoms  always  remain  debatable  in  a 
certain  proportion  of  cases,  or,  in  other  words,  there  is  no 
sign  or  symptom  that  is  reliable  and  if  reliable  it  is  not  uni- 
formly present  From  a  medico-legal  standpoint  the  ques- 
tion will  always  be  of  great  importance,  as  it  frequently 
involves  the  guilt  or  innocence  of  the  accused;  the  social 
standing  of  one,  or  the  merited  punishment  of  the  other,  and 
it  does  seem  like  a  travesty  on  both  science  and  justice  that 
at  certain  stages  and  in  certain  conditions  no  signs  or  symp- 
toms are  absolutely  reliable.  The  unfortunate  creatures 
whose  illness  may  imitate  or  simulate  the  symptoms  of  preg- 
nancy must  always  receive  the  benefit  of  the  doubt,  this 
would  avoid  the  possibility  of  wrecking  innocent  lives.  Pro- 
fessor Bedford  reports  a  case  in  his  work  on  obstetrics  which 
is  as  sad  as  it  is  instructive,  he  says:  "I  was  requested  to 
visit  a  lady  who  was  residing  in  the  State  of  New  Jersey, 
about  thirty  miles  distant  from  New  York.     On  my  arrival 


312  HOME   TREATMENT. 

I  was  received  by  her  father,  a  venerable  and  accomplished 
gentleman.  He  seemed  broken  in  spirit,  and  it  was  evident 
that  grief  had  taken  a  deep  hold  of  his  frame.  On  being 
introduced  into  his  daughter's  room,  my  sympathies  were  at 
once  awakened  in  beholding  the  wreck  of  beauty  which  was 
presented  to  my  view.  My  presence  did  not  seem  to  occasion 
the  slightest  disturbance;  she  greeted  me  with  these  words: 
'Well,  doctor,  I  am  glad  to  see  you  on  my  beloved  father's 
account,  for  he  will  not  believe  that  I  cannot  yet  be  restored 
to  health.  Life,  however,  has  lost  all  its  charms  for  me,  and 
I  impatiently  long  for  the  repose  of  the  grave.'  These  words 
were  spoken  with  extraordinary  gentleness,  but  yet  with  an 
emphasis  which  at  once  gave  me  an  insight  into  the  character 
'of  this  lovely  woman. 

"  Her  father  was  a  clergyman  of  high  standing  in  the 
English  Church,  and  had  a  pastoral  charge  in  England,  in 
which  he  continued  until  circumstances  rendered  it  neces- 
sary for  him  to  leave  that  country,  and  seek  a  residence  in 
America.  At  a  very  early  age,  this  young  lady  had  lost  her 
mother,  and  had  almost  been  entirely  educated  by  her 
father,  whose  talents,  attainments,  and  moral  excellence  ad- 
mirably fitted  him  for  this  important  duty.  When  she  had 
attained  her  eighteenth  year,  an  attachment  was  formed  be- 
tween her  and  a  young  barrister  of  great  promise  and  respec- 
tability. This  attachment  soon  resulted  in  a  matrimonial 
engagement.  Shortly  after  the  engagement  she  began  un- 
accountably to  decline  in  health ;  there  was  a  manifest  change 
in  her  habits ;  she  was  no  longer  fond  of  society ;  its  pleas- 
ures ceased  to  allure  and  prove  attractive;  the  friends  whom 
she  had  caressed  with  all  the  warmth  of  a  sister's  love,  now 
became  objects  of  indifference;  in  a  word  she  was  a  changed 
being — her  personal  appearance  exhibited  alterations  evident 
to  the  most  superficial  observer;  her  abdomen  enlarged,  the 
breasts  fuller  than  usual,  the  face  pale  and  careworn,  and 
the  appetite  capricious,  with  much  gastric  derangement. 
Many  were  the  efforts  made  to  account  for  this  change  in 


SIGNS   AND   SYMPTOMS   OF   PREGNANCY.  313 

the  conduct  and  appearance  of  the  young  lady  in  question. 
Speculation  was  at  work,  and  numerous  were  the  surmises 
of  her  friends.  The  rumor  soon  spread  that  she  was  the 
victim  of  seduction,  and  her  altered  appearance  the  result  of 
pregnancy. 

"The  barrister  to  whom  she  was  affianced  heard  of  these 
reports,  and  instead  of  being  the  first  to  stand  forth  as  her 
protector, and  draw  nearer  to  his  heart  this  lovely  and  injured 
girl  thus  measurably  assuaging  the  intensity  of  grief  with 
which  she  was  overwhelmed,  addressed  a  letter  to  her  father 
requesting  to  be  released  from  his  engagement.  This  was, 
of  course,  assented  to  without  hesitation.  The  daughter, 
conscious  of  her  own  innocence,  knowing  better  than  any- 
one else,  her  own  immaculate  character,  and  relying  on 
heaven  to  guide  her  in  this  her  hour  of  tribulation,  requested 
that  a  physician  should  be  sent  for,  in  order  that  the  nature 
of  her  case  might  be  clearly  ascertained.  A  medical  man 
visited  her,  and  after  an  investigation  of  her  symptoms,  in- 
formed the  father  that  she  was  undoubtedly  pregnant,  and 
suggested  that  means  should  be  taken  to  keep  the  unpleas- 
ant matter  secret.  The  father,  indignant  at  this  cruel  im- 
putation against  the  honor  of  his  child,  requested  an 
additional  consultation.  This  resulted  (as  usual)  in  a  con- 
firmation of  the  opinion  previously  expressed,  and  the  feel- 
ings of  that  parent  can  be  better  appreciated  than  portrayed. 

"That  good  man  resigned  his  pastoral  living  to  proceed 
with  his  daughter  to  America.  On  her  passage  to  this 
country,  the  daughter  became  extremely  ill,  and  the  advice 
of  the  physician  on  board  the  vessel  was  requested;  he  too 
told  the  father  that  there  was  danger  of  premature  delivery, 
for  he  simply  took  appearances  as  his  guide,  and  at  once 
concluded  that  she  was  pregnant. 

"This  is  about  the  substance  of  what  I  learned  of  this 
interesting  and  extraordinary  woman.  I  proceeded  with 
great  caution  in  the  investigation  of  her  case,  and  after  a 
faithful  and  critical  survey,  most  minutely  made  in  reference 
to  every  point,  I  stated  in  broad  and  unequivocal  language 


314  HOME   TREATMENT. 

that  she  was  not  pregnant.  The  only  reply  the  gentle  crea- 
ture made  on  hearing  my  opinion,  was — '  Doctor,  you  are 
right.'  The  father  was  soon  made  acquainted  with  the  re- 
sult of  my  examination,  but  he  indicated  not  the  slightest 
emotion.  He  asked  me  whether  something  could  not  be  done 
to  restore  her  to  health,  and  I  thought  that  the  old  man's 
heart  would  break  when  I  told  him  that  his  daughter  was 
in  the  last  stages  of  consumption. 

"It  was  the  misfortune  of  this  young  lady  to  labor  under 
an  affection  of  the  womb,  which  simulated,  in  several  im- 
portant particulars,  the  condition  of  pregnancy,  and  which 
the  world  in  its  ignorance  and  undying  thirst  for  scandal, 
might  have  readily  supposed  did  in  fact  exist ;  yet,  there 
was  no  excuse  for  the  physician,  guided  as  he  should  have 
been  by  the  lights  of  science,  and  governed  by  the  principles 
of  sound  morality.  The  result  of  my  investigation  impressed 
me  with  the  conviction  be}Tond  any  shade  of  doubt,  that 
the  entire  train  of  symptoms  indicating  pregnancy  was  due 
to  the  presence  of  a  large  fibrous  tumor  occupying  the 
cavity  of  the  uterus.  About  four  weeks  from  this  time  I 
received  a  note  announcing  her  death  and  asking  that  I 
would  hasten  to  the  house  for  the  purpose  of  an  examina- 
tion. Dr.  Ostrom,  now  practicing  in  Goshen,  assisted  me  in 
the  autopsy.  As  the  father  stood  before  me  he  was  not  un- 
like the  stricken  oak  in  the  forest,  which,  though  stripped 
of  its  branches,  was  yet  upright  and  majestic.  The  moment 
I  removed  the  tumor  from  the  womb  he  seized  it  convul- 
sively, and  exclaimed,  'This  is  my  trophy;  I  will  return 
with  it  to  England,  and  it  shall  confound  the  traducers  of 
my  child!' 

"Here,  you  perceive,  both  character  and  life  were  sacri- 
ficed by  error  of  judgment  on  the  part  of  those  whose  coun- 
sel had  been  invoked.  Without  a  due  responsibility,  heed- 
less of  the  distressing  consequences,  the  medical  gentlemen 
rashly  pronounced  an  opinion  which  consigned  to  an  early 
grave  a  pure  and  lovely  being,  and  broke  the  very  heart 
strings  of  a  devoted  and  confiding  parent." 


CHAPTER   XXVII. 

PRECAUTIONS  AND   SUGGESTIONS  TO  PREGNANT 

WOMEN. 

There  is  a  hygiene  of  pregnancy  which  the  enceinte  fe- 
male should  observe,  for  by  so  doing,  she  will  not  only 
make  the  period  of  her  gestation  less  onerous  to  herself,  but 
she  will  be  able  to  materially  contribute  toward  the  accom- 
plishment of  a  natural  childbirth.  Although  pregnancy  is 
a  physiological  process,  the  conditions  in  the  female  econ- 
omy, under  which  this  is  carried  on,  are  at  variance  with 
those  which  are  to  be  found  in  the  unimpregnated  state,  and 
as  a  consequence  it  rationally  follows  that  the  pregnant 
female  should  endeavor  to  conform  to  the  demands  which 
the  altered  relations  require. 

If  the  pregnant  woman  is  properly  clothed  to  begin  with, 
she  will  greatly  mitigate  some  of  the  symptoms  which  very 
often  mar  her  well-being.  The  clothing  should  neither  be 
too  heavy  in  summer,  nor  too  light  in  winter,  she  must  dress 
so  as  to  conform  to  the  season  and  feel  comfortable;  but  by 
all  means  the  chest  and  abdomen  should  be  kept  free  from 
pressure,  the  skirts  must  be  supported  from  the  shoulders, 
and  the  corset  also,  should  be  dispensed  with,  and  a  waist 
worn  instead,  one  that  partly  answers  the  purpose  of  a  cor- 
set, and  to  which  the  skirts  can  be  fastened  or  buttoned  at 
the  same  time.  I  have  no  respect  nor  patience  for  those 
women  who  desire  to  conceal  by  tight  lacing,  the  appearance 
of  their  pregnancy.  Motherhood,  whether  active  or  pros- 
pective, is  a  divine  function,  and  as  creatures  are  the  instru- 
ments of  the  Creator,  there  is  nothing  to  be  ashamed  of  by 
those  who  have  complied  with  the  usages  of  civilized  peo- 

(315) 


316  HOME   TREATMENT. 

pies,  and  wherever  an  exhibition  of  pregnancy  becomes  in- 
delicate, a  person  who  hopes  or  expects  to  be  a  mother 
should  not  be.  If  a  woman  has  the  true  characteristics  to 
make  a  good  mother,  she  cannot,  nor  will  she  trifle  with  her 
own  health  or  that  of  her  child ;  in  truth,  mothers  cannot 
begin  too  soon  to  consider  the  welfare  of  their  offspring. 

To  guard  against  taking  cold  is  one  of  the  maxims,  that 
the  pregnant  woman  should  heed,  especially  during  the  last 
half  of  gestation  when  the  prominence  of  the  abdomen 
shortens  the  skirts  in  front  and  removes  them  off  from  the 
limbs.  Flannel  drawers  properly  adapted  to  the  limbs  and 
worn  underneath  the  muslin  ones  affords  the  best  protection 
that  can  be  adopted,  and  it  replaces  cumbersome  skirts. 
Sudden  extreme  variations  of  temperature  should  also  be 
avoided,  like  going  from  an  overheated  apartment  into  the 
cold  outside  air,  or  into  another  cold  chilly  room.  In  mak- 
ing these  changes,  one  should  gradually  cool  off,  and  then 
by  putting  on  additional  clothing,  wraps  or  shawls,  the  dan- 
ger of  taking  cold  may  be  removed.  Hot  coffee  or  tea  or 
hot  alcoholic  beverages  are  equally  as  dangerous  as  over- 
heated apartments,  for  anything  which  stimulates  the  cir- 
culation of  the  blood  in  an  inordinate  degree  is  liable  to 
produce  a  congestion  of  the  placenta,  and  thus  incite  an 
abortion;  hence  fevers  of  all  kinds  are  known  to  have 
brought  about  an  expulsion  of  the  fetus.  On  the  whole, 
either  very  hot  or  very  cold  temperatures  are  to  be  avoided, 
for  instance,  prolonged  staying  in  cold  weather  or  lengthened 
exposure  to  the  rays  of  the  sun  should  be  prudently  guarded 
against  by  the  pregnant  female.  Of  course  this  is  not  to  be 
construed  as  meaning,  that  she  should  not  partake  of  exer- 
cise in  the  open  fresh  air — far  from  it,  but  the  exercise 
shall  not  be  forced  or  driven,  it  shall  at  all  times  be  volun- 
tary and  passive,  so  that  when  a  tired  feeling  comes  on,  she 
can  rest  and  refresh  herself.  The  best  time  for  these  little 
walks  is  in  the  morning  and  evening  in  the  summer  season 
and  in  the  middle  of  the  day  in  cold  weather.     A  rough, 


PRECAUTIONS  TO   PREGNANT   WOMEN.  317 

uneven  walk  should  be  avoided  because  she  may  stumble; 
jolting  in  either  street  cars  or  wagon  is  equally  pernicious. 
A  great  deal  of  stair  climbing  is  injurious,  and  when  it  be- 
comes necessary  it  must  be  done  slowly;  running  the  sewing 
machine  has  caused  many  miscarriages.  Avoid  running, 
jumping,  riding  on  horseback,  and  lifting  heavy  weights, 
hanging  laundried  clothes  on  lines,  in  facteverything  that  can 
strain  the  muscles,  bear  down,  increase  the  intra-abdominal 
pressure  and  excite  the  nervous  system. 

The  prospective  mother  must  resign  her  amusements  at 
evening  entertainments  in  crowded  halls  or  theaters,  in 
which  the  air  becomes  foul  and  overheated  from  large  con- 
gregations of  persons.  Here  she  is  also  threatened  to  be 
jostled  and  jammed,  and  perhaps  injured  in  other  ways. 
Her  sleeping  apartments  should  be  thoroughly  ventilated 
through  the  day,  and  coition,  if  not  entirely  suspended,  at 
least  restrained  and  only  passively  exercised,  for  any  excess 
of  this  nature  is  not  only  injurious  to  the  child,  but  may 
cause  a  miscarriage.  It  is  not  expected  that  the  pregnant 
woman  should  sit  in  the  arm  chair  during  the  period  of 
gestation,  far  from  it,  but  it  is  even  greatly  desired  that  she 
continue  her  usual  vocation.  Exercise  of  a  passive  nature 
is  always  wholesome,  and  for  this  reason  it  will  be  condu- 
cive to  good  health  if  enough  work  is  done  over  every  day 
to  keep  the  system  in  gentle  activity;  the  domestic  duties  of 
a  household  will  or  should  always  furnish  that.  All  good 
women  take  a  pride  in  their  household  affairs',  if  they  do 
not  they  are  not  good ;  and  those  who  boast  that  they  never 
put  their  hands  to  anything  in  the  house,  have  mistaken 
their  vocation  as  women,  and  are  either  indolent  or  worth- 
less, and  often  both.  No  one  should  boast  of  idleness, 
rather  be  ashamed  of  it.  Employment  makes  character;  it 
gives  buoyancy  to  the  spirit  and  tranquillity  of  mind.  The 
influence  that  an  equable  temperament  exercises  over  the 
nervous  development  of  the  unborn  child  may  eventually 
be  demonstrated  by  its  resistance  to  the  shock  of  diseases 
which  superinduce  convulsions  and  death. 


318  HOME   TREATMENT. 

It  is  not  advisable  to  sleep  during  the  day,  it  is  better  to 
retire  early  after  a  light  supper,  so  as  to  rest  a  few  hours 
before  midnight.  This  makes  one  fresh  and  spry  in  the 
morning,  being  on  hand  early  in  the  morning,  it  gives 
ample  time  to  dispose  of  domestic  duties,  and  thus  avoid 
confusion  and  rushing  during  the  day. 

Cleanliness  is  one  of  the  cardinal  virtues  of  the  pregnant 
woman — as  pregnancy  will  be  followed  with  childbirth,  and 
as  cleanliness  is  but  another  name  for  antiseptic,  and  that  will 
guard  against  childbed  fever,  the  importance  of  cleanliness 
springs  at  once  into  unusual  prominence.  No  person  can  be 
filthy  and  slovenly  during  the  entire  period  of  gestation,  and 
then  at  the  moment  of  confinement  become  clean,  even  if 
in  the  last  moment  the  person  becomes  bathed  and  brushed, 
everything  else  around  and  about  her  is  soiled  and  dirty, 
unless  she  be  taken  to  a  lying-in  home.  Cleanliness  must 
be  cultivated,  and  finally  it  becomes  second  nature.  The 
daily  ablution  of  the  external  genitals  should  not  be  neglected, 
and  general  bathing  in  water  not  altogether  too  warm,  say 
90  to  94  degrees  F.,  twice  a  week  will  prove  beneficial  in 
many  ways.  The  linen  that  is  worn,  and  that  which  is  in 
the  bed  should  be  kept  sweet  and  clean,  and  cleaner  than 
ever  on  the  day  of  confinement. 

The  mamma?  of  the  pregnant  woman  are  sometimes  very 
painful;  as  pregnancy  advances  they  enlarge,  the  lacteal 
glands  become  congested  and  swollen.  To  relieve  this  I 
recommend  the  application  of  a  liniment  of  equal  parts 
camphorated  oil,  laudanum,  and  tincture  of  belladonna 
gently  applied  several  times  a  day.  The  breasts  should 
always  be  extra  well  covered  with  flannel  so  as  not  to  take 
cold  in  them,  otherwise  an  abscess  may  form  in  them  long 
before  the  child  is  born.  If  the  nipples  are  sensitive  it  is 
advisable  to  begin  to  harden  them  during  the  last  few  months 
of  gestation.  Tannate  of  glycerine  is  perhaps  the  best  thing 
to  apply  for  this  purpose;  it  is  best  done  by  means  of  a  small 
camel's  hair  brush.     If  the  nipples  are  sunken   into  the 


PRECAUTIONS   TO   PREGNANT   WOMEN.  319 

breast,  and  too  short  for  subsequent  use  for  the  baby,  it  is 
well  to  draw  them  out  by  means  of  a  breast  pump,  the  bowl 
of  a  new  clay  pipe,  or  by  employing  a  bottle  from  which  the 
air  has  been  replaced  by  filling  it  with  hot  water  and  then 
pouring  it  out;  the  mouth  of  the  hot  bottle  is  applied  over 
the  depressed  nipple,  and  as  it  cools  off,  the  vacuum  thus 
formed  draws  the  nipple  out. 

Nausea  and  vomiting  in  pregnancy  is  often  so  annoying 
and  weakening  that  the  strength  of  the  patient  becomes 
seriously  threatened,  and  hence  some  measures  must  be 
employed  to  counteract  it.  A  great  variety  of  agents  have 
been  suggested  for  this  purpose.  Tincture  of  nux  vomica  in 
two  or  three  drop  doses  every  three  or  four  hours  is  a  useful 
remedy;  the  oxalate  of  cerium  is  another  valuable  agent  for 
this  purpose,  in  five  to  ten  grain  doses  three  times  a  day,  but 
a  more  valuable  remedy  than  any  other  that  I  know,  is  the 
Femina  vaginal  capsule,  to  be  used  every  night  at  bedtime, 
and  in  severe  cases,  also  in  the  morning. 

Salivation  is  not  constantly  an  attendant  upon  pregnancy, 
but  when  it  does  occur  it  is  weakening  and  debilitating. 
There  are  many  remedies  for  this  disorder,  but  one  of  the 
most  effectual  ones  is  an  occasional  dose  of  Epsom  salts,  say 
a  teaspoonful  in  a  half  tumbler  of  water  every  other  morn- 
ing, so  as  to  produce  free  discharges  from  the  bowels ;  when 
salts  are  found  objectionable,  the  Femina  laxative  syrup 
taken  in  doses  that  have  a  similar  effect  will  be  a  most  excel- 
lent substitute. 

Constipation  is  one  of  the  most  common  derangements 
of  the  pregnant  woman;  it  is  the  rule  in  which  the  exceptions 
are  few  and  far  between.  I  do  not  include  those  cases  of 
costiveness  which  are  habitual,  and  which  are  to  be  attributed 
to  carelessness  in  not  responding  to  nature's  call  when  there 
is  an  inclination,  but  to  those  in  which  constipation  is  con- 
temporaneous with  pregnancy.  We  have  already  seen  the 
sympathy  between  the  stomach  and  other  organs  in  preg- 
nancy, and  that  a  similar  derangement  should  exist  between 


320  HOME   TREATMENT. 

the  uterus  and  rectum  is  not  at  all  unreasonable,  and,  indeed, 
it  can  be  explained  in  that  way.  In  the  early  months  of 
pregnancy,  the  torpor  of  the  bowels  may  be  due  to  the  gen- 
eral derangement  which  follows  digestive  disturbances;  in 
the  latter  months,  the  enlarged  uterus  presses  against  the 
large  intestines,  so  as  to  obstruct  more  or  less  the  descent  of 
the  feces  into  the  rectum.  This  torpor  of  the  bowels  should 
not  be  allowed  to  be  unrelieved,  for  if  permitted  to  continue 
it  may  not  only  induce  a  miscarriage,  but  it  is  apt  to  cause 
fever,  headache  and  loss  of  appetite.  Harsh  cathartics 
must  not  be  employed;  and  if  a  simple  enema  of  warm 
water  early  every  morning  does  not  give  the  desired  relief,  I 
would  recommend  a  daily  dose  of  Femina  laxative  syrup. 
If  it  is  found  that  in  attempting  to  administer  an  enema,  the 
fluid  is  immediately  returned,  then  it  will  probably  be  owing 
to  lumps  of  fecal  matter  which  clog  up  the  rectum;  this 
will  likely  give  rise  to  more  or  less  straining  or  bearing 
down  in  the  back  passage,  and  to  pains  in  the  pelvis  and 
lower  limbs,  all  of  which  is  not  without  danger  of  exciting 
premature  labor  pains;  the  fecal  lumps  must  be  removed 
even  if  it  becomes  necessary  to  use  the  finger. 

Diarrhea  is  the  opposite  condition  of  things,  namely  a 
looseness  of  the  bowels.  This  may  be  occasioned  by  im- 
proper food,  cold  or  any  other  cause  capable  of  producing 
diarrhea  when  pregnancy  does  not  exist.  Habitual  costive- 
ness  is  often  followed  by  diarrhea  from  the  irritation  whicli 
the  hardened  feces  excite.  A  dose  of  castor  oil  is  sometimes 
an  efficient  remedy  for  this  variety  of  diarrhea,  but  when  the 
disease  becomes  obstinate  and  painful,  the  following  remedy 
can  always  be  depended  upon  for  relief: — 
Take:  Tr.  of  catechu. 

Tr.  of  kino,  of  each 4  drams 

Paregoric 1  ounce 

Chalk  mixture 2  ounces 

Mix  and  take  a  tablespoonful  every  four  hours  until 
relieved. 


PRECAUTIONS    TO   PREGNANT   WOMEN.  321 

Bladder  trouble  is  not  infrequent  in  the  early  and  last 
stages  of  pregnancy;  the  causes  of  this  were  pointed  out 
when  the  symptoms  of  pregnancy  were  inquired  into. 
Recipe  No.  V  is  sometimes  very  useful  to  relieve  this  irri- 
tability, or  a  Femina  vaginal  capsule  introduced  into  the 
vagina  every  night  at  bedtime,  is  sure  to  give  the  desired 
relief. 

The  kidneys  of  pregnant  women  should  not  be  neglected. 
On  this  question  Dumas,  an  eminent  French  authority,  says: 
"Physiological  pregnancy,  by  modifying  the  quality  and 
quantity  of  the  blood  is  a  predisposing  general  cause  of 
albuminuria  or  Bright's  disease.  But  to  produce  the  last  a 
cause  must  be  added,  and  this  may  be  due  to  a  true  patho- 
logical state  of  the  blood,  a  morbid  condition  of  the  kidney, 
an  accidental  cause  or  mechanical  pressure  exerted  by  the 
uterus,  where  it  has  acquired  a  sufficient  size."  If  the 
pregnant  woman  notices  that  her  urine  becomes  thick  and 
foamy,  that  her  head  aches  and  her  limbs  swell,  she  should 
pay  particular  attention  to  keep  her  bowels  free,  and  besides 
drink  a  cupful  of  buchu  tea  every  night  at  bedtime. 

Palpitation  of  the  heart  is  a  source  of  great  annoyance 
to  some  women  in  the  earlier  months  of  pregnancy.  Women 
of  a  nervous  temperament  and  those  who  are  of  a  full  ple- 
thoric habit  are  most  likely  to  suffer  from  distressing  palpita- 
tion. Nervous  women  should  take  ten  grains  of  bromide  of 
sodium  in  half  tumbler  of  water  at  bedtime,  and  only  a 
very  light  supper,  while  those  who  are  full  blooded  should 
keep  their  bowels  freely  opened  and  remove  all  pressure 
from  the  chest  and  abdomen  by  wearing  the  clothing  loose. 

Pain  in  the  abdomen  walls  from  the  sixth  to  the  ninth 
month  is  particularly  apt  to  occur  in  the  first  pregnancy. 
The  abdominal  walls  offer  a  firm  resistance  to  the  growth  of 
the  uterus,  and  being  thus  put  on  the  stretch  by  the  com- 
bined development  of  the  child  and  the  womb,  the  muscles 
and  skin  become  excessively  tender  and  painful.  I  have 
recommended  for  this  complaint: — 
21 


322  HOME   TREATMENT. 

Take:  Tr.  of  opium  (laudanum). 

Glycerine,  of  each 1  ounce 

Mix  and  apply  by  means  of  gentle  friction  every  night 
at  bedtime  or  night  and  morning. 

Itching  of  the  external  organs  will  sometimes  make  the 
life  of  the  pregnant  woman  miserable.  I  have  seen  it  in  so 
aggravated  a  form  that  the  constant  scratching  to  which  the 
patient  had  recourse  in  the  hope  of  being  relieved,  lacerated 
the  parts  so  that  they  became  ulcerated.  The  causes  of  this 
condition  are  numerous,  the  patient  from  motives  of  delicacy 
conceals  her  suffering  until  she  can  endure  it  no  longer.  It 
also  happens  that  pregnancy  has  nothing  at  all  to  do  with 
the  itching  for  it  may  be  due  to  diabetes,  inattention  to  per- 
sonal cleanliness,  the  presence  of  small  parasitic  insects,  acrid 
discharges  from  the  vagina,  or  from  pinworms  in  the  rectum. 

If  owing  to  parasites,  mercurial  ointment  will  cure  the 
disease,  if  from  vaginal  discharges  warm  vaginal  douches 
in  which  the  Femina  antiseptic  tablets  are  dissolved  will  be 
the  efficient  remedy,  and  after  a  thorough  ablution,  the  appli- 
cation by  means  of  a  camel's  hair  brush  of  a  solution  of 
cocaine  will  relieve  the  itching. 

Hemorrhoids,  or  piles,  frequently  torment  the  pregnant 
female  beyond  reasonable  endurance.  Piles  may  be  either 
external  or  internal,  in  either  case  they  are  exceedingly  apt 
to  be  very  painful.  When  they  occur  in  pregnancy  they  are 
due,  in  the  first  place,  to  an  obstruction  to  the  free  return  of 
blood  to  the  heart  by  the  enlarged  uterus  pressing  on  the 
large  venous  trunks  and  secondly,  to  constipation,  which  as 
we  have  learned  is  so  frequently  an  attendant  upon  preg- 
nancy. If  the  piles  bleed  it  may  give  temporary  relief,  but 
if  the  bleeding  occurs  too  frequently,  the  patient  becomes 
pale  and  weak  from  the  loss  of  blood.  I  know  of  no  painful 
and  troublesome  malady  in  which  the  application  of  a  little 
common  sense  has  greater  brilliant  results  than  in  piles,  yet 
of  all  maladies,  with  perhaps  the  exception  of  catarrh  of 
the  nose,  it  is  the  most  abused  by  senseless  and  meddlesome 


PRECAUTIONS   TO    PREGNANT   WOMEN.  323 

•doctoring.  The  first  step  to  engage  the  attention  of  the 
patient  is  to  regulate  the  bowels  and  overcome  the  constipa- 
tion; the  passages  must  be  kept  soft  and  soluble,  unless  this 
is  accomplished  all  the  other  efforts  fail.  The  constipation 
must  be  partly  relieved  by  proper  dieting,  and  partly  by 
suitable  remedies.  A  simple  bland  diet,  for  a  short  time  at 
least,  is  very  useful;  bread  and  milk,  thin  milk  gruel,  fruits 
and  vegetables  are  to  be  preferred;  abstain  from  solids,  from 
meat  and  eggs  and  everything  of  the  nature  of  beer  and 
wine  or  alcohol,  even  coffee  is  irritating;  while  the  disease 
is  at  its  height  eat  sparingly  of  everything,  but  drink  plenty 
of  water,  warm  or  cold,  but  not  iced  cold.  The  bowels  should 
be  regulated  by  taking  a  mild,  efficient  laxative,  none 
being  better  than  the  Femina  laxative  syrup.  Another 
precaution,  very  essential  to  success,  is  that  after  each  stool 
the  parts  are  gently  bathed  and  washed  with  tepid  or  cool 
water  by  means  of  a  soft  sponge;  gentle  pressure  can  be 
exerted  at  the  same  time  so  as  to  assist  the  piles  to  return 
into  the  rectum.  If  they  cannot  be  returned  in  this  manner, 
the  patient  must  learn  to  use  her  index  finger  and  with  it 
oiled  with  a  little  sweet  oil  or  vaseline  the  piles  are  gradually 
shoved  back  into  the  rectum  which  alone  relieves  the  suffer- 
ing, because  it  relieves  the  strangulation  and  swelling  which 
the  sphincter  muscle  of  the  rectum  causes.  The  pushing 
back  after  each  stool  and  even  between  times  is  one  of  the 
essential  features  of  a  successful  home  treatment  for  piles, 
and  it  must  be  kept  up  for  years,  if  necessary,  to  insure  com- 
fort and  to  guard  against  a  relapse.  Better  than  plain  oil 
or  vaseline  is  the  nutgall  ointment  to  be  had  at  any  drug 
store,  but  if  the  pain  and  distress  continue  use  the  following 
recipe : — 

Take:  Cocaine. 

Ex.  Belladonna,  of  each 10  grains 

Vaseline 4  drams 

Mix  and  make  into  an  ointment;  apply  to  the  piles  at 
bedtime  or  whenever  they  come  down  and  have  to  be  re- 


324  HOME   TREATMENT. 

turned;  a  few  days  in  bed  will  materially  aid  in  the  recov- 
ery. 

The  diet  of  the  pregnant  female  should  be  made  a  special 
study  for  upon  the  regimen  of  food  not  only  depends  her  im- 
mediate comfort,  but  its  ultimate  effect  on  the  process  of 
parturition  is  equally  marked.  I  do  not  agree  with  the 
opinion,  laid  down  by  some  of  the  highest  authorities,  that 
"as  far  as  eating  and  drinking  is  concerned,  the  pregnant 
woman  may  continue  her  accustomed  diet."  I  believe  that 
there  is  a  diet  peculiarly  adapted  to  the  pregnant  woman 
and  very  beneficial  to  her  if  she  lives  up  to  it.  Stimulants  of 
every  kind  are  not  good;  wine,  beer,  whisky  and  even 
strong  coffee  and  tea,  as  well  as  highly  seasoned  food,  salty 
or  sour  salads  should  not  be  eaten. 

How  very  often  does  it  happen  that  a  very  strong,  muscu- 
lar, robust,  healthy  young  woman,  who,  during  her  entire 
period  of  gestation, was  in  the  best  of  health  and  spirits,  and 
from  whom,  from  all  appearances  one  may  predict  that  she 
will  have  an  "easy  time"  in  her  confinement,  quite  the 
opposite  occurs.  And  why  as  a  matter  of  fact  and  expe- 
rience is  this  not  so,  is  indeed  an  interesting  inquiry.  I  be- 
lieve that  the  answer  to  this  question  can  be  made  so  plain 
and  reasonable,  that  a  mere  statement  of  a  few  simple  facts 
will  make  it  apparent. 

The  process  of  delivery,  presupposes  the  contraction  of 
the  uterus  and  the  descent  of  the  child  down  into  the  pelvic 
canal  and  its  further  passage  through  the  floor  of  the  pelvis. 

The  pelvic  floor  (see  page  228)  forms  the  bottom  of  the 
pelvic  canal  through  which  the  child  must  be  forced.  The 
vagina  is  the  opening  through  this  floor,  and  this  is  com- 
posed of  the  muscles  and  membranes  of  the  vagina,  the  skin, 
two  layers  of  fascea,  the  triangular  ligaments  of  the  bladder 
and  a  group  of  interlacing  muscles.  In  the  birth  of  the 
child  all  these  tissues  are  forced  to  relax  to  such  an  extent, 
that  the  vaginal  canal  (or  the  vagina)  will  be  sufficiently 
widened  or  dilated  to  allow  the  child  to  pass  through  into' 


PRECAUTIONS   TO   PREGNANT   WOMEN.  325 

the  world.  A  moment's  reflection  will  at  once  make  clear, 
that  in  a  strong  muscular  person,  the  resistance  to  the  neces- 
sary dilatation  will  become  correspondingly  great,  because 
the  muscles  are  so  strong  and  tense.  I  have  attended  some 
women  where  the  muscles  under  the  excitement  of  labor 
pains  felt  as  tense  and  hard,  as  though  they  were  made  of 
strong  india  rubber.  It  is  apparent  that  the  muscular 
resistance  that  is  offered  by  these  strong,  tense  muscles, 
clearly  obstructs  and  delays  the  passage  or  birth  of  the  child 
and  it  makes  the  strongest  labor  pains  of  no  avail.  And  ex- 
perience teaches,  that  the  progress  of  labor  is  slow  and  the 
delivery  generally  prolonged  until  the  pains  and  physical 
suffering  of  many  hours,  exhaust  and  relax  the  muscular 
resistance  so  that  the  child  is  allowed  to  pass.  If  the  above 
truths  were  generally  understood  and  generally  recognized 
they  might  be  guarded  against  by  a  proper  dietetic  regula- 
tion, and  thus  an  infinite  amount  of  suffering  could  be 
avoided. 

Painless  childbirth  is  only  relative,  and  in  the  absolute 
meaning  of  the  term  it  is  not  true,  and  for  this  reason,  that 
severe  contractions  of  the  womb  are  always  painful,  and  ex- 
treme tension  of  tissues  and  muscles  such  as  the  passage  of 
the  child  will  occasion  in  its  passage  through  the  soft  parts 
is  also  more  or  less  painful  and  there  is  no  natural, child- 
birth possible  without  both  these  factors  being  present. 
Painless  childbirth  in  its  absolute  sense,  as  a  scientific  fact, 
is  not  true,  but  to  assure  a  comparatively  painless  childbirth 
in  accordance  with  scientific  facts  which  are  capable  of  dem- 
onstration is  not  only  reasonable  but  absolutely  true. 

The  term  "food"  is  understood  to  be  all  those  substances, 
solid  and  liquid,  which  are  used  for  the  process  of  nutrition. 
For  our  present  purpose  foods  may  be  divided  into  three 
classes:  carbo-hydrates,  albuminoids,  and  phosphates. 

The  carbo-hydrates  furnish  fat  and  warmth,  as  an  exam- 
ple we  have  starch,  sugar,  and  fats.     Persons  who  are  fed 


326  HOME   TREATMENT. 

principally  upon  this  class  become  warm  and  fat,  but  will 
lack  muscle  and  nerve. 

The  albuminoids  are  also  termed  nitrogenous  substances, 
and  constitute  the  muscle  making  material.  They  are  de- 
rived both  from  animal  and  vegetable  sources,  and  in  their 
most  concentrated  form  we  find  them  in  eggs,  milk  or  cheese, 
and  in  meats  also  in  certain  meals;  wheat,  for  instance,  con- 
tains fourteen  per  cent  of  nitrate  or  muscle-making  material. 

Phosphates  are  generally  taken  into  the  system  as  phos- 
phate of  lime  contained  in  certain  foods  we  eat,  as  fish,  lob- 
ster, beef,  Southern  corn,  peas  and  beans,  barley,  sweet 
potatoes  and  oats. 

It  is  obvious  from  what  was  said  of  painful  and  prolonged 
childbirth,  that  the  pregnant  woman  should  avoid  as  much 
as  possible  nitrogenous  or  muscle-making  food;  she  must 
starve  her  muscular  system  as  much  as  it  is  possible  for  her  to 
do,  and  the  result  will  be  that  her  muscles  will  become  soft 
and  relaxable  and  that  means  a  comparatively  easy  or  pain- 
less childbirth.  In  Europe,  the  peasantry  who  eat  meat 
sparingly  or  very  seldom,  have  comparatively  little  pain, 
because  vegetables  enter  largely  into  their  daily  diet;  the 
same  is  true  in  Asiatic  countries  where  the  staple  is  rice, 
the  throes  of  labor  are  very  light.  The  squaws  of  our  Indian 
tribes  are  remarkable  for  the  little  pain  they  suffer  in  child- 
birth and  for  the  shortness  of  its  duration,  and  the  recuper- 
ation is  also  a  speedy  one,  for  an  Indian  woman  will  travel 
or  be  about  in  a  few  days  after  her  confinement  with  her 
pappoose  on  her  back. 

I  would  recommend  to  the  pregnant  woman  to  live  as  much 
as  it  is  possible  for  her  to  do  on  a  fruit  and  vegetable  diet. 
Her  meals  must  be  taken  at  regular  intervals,  otherwise 
derangement  of  the  stomach  is  sure  to  follow.  Excess  in 
eating  even  the  plainest  kind  of  food  must  be  studiously 
avoided,  and  all  food  must  be  eaten  slowly  and  thoroughly 
masticated.     Wheaten  bread  or  rice  and  milk  diluted  with 


PRECAUTIONS  TO   PREGNANT   WOMEN.  327 

water  should  form  the  main  diet.  Thoroughly  cooked  garden 
vegetables  and  fresh,  ripe  fruit  like  apples,  grapes,  peaches, 
plums,  etc.,  should  be  used  in  summer,  and  some  of  the  same 
fruits  canned  in  winter,  or  dried  fruits  slowly  simmered  until 
they  are  soft;  it  is  always  better  to  soak  dried  fruit  for  several 
hours  or  overnight  before  it  is  put  over  to  boil. 


CHAPTER    XXVIII. 

WHILE  IN  CHILDBED. 

By  childbed  is  usually  meant  the  period  of  delivery,  but 
I  mean  to  include  the  lying-in  period,  from  the  moment 
the  mother  has  the  first  signs  of  her  approaching  delivery, 
to  the  time  when  she  is  supposed  to  have  fully  recovered 
and  is  able  to  be  out  of  her  bed  and  about. 

If  the  suggestions  that  were  thrown  out  in  a  former  chap- 
ter are  complied  with,  there  will  be  little  reason  for  un- 
easiness for  the  prospective  mother,  but  it  will  be  conducive 
to  her  welfare  if  she  be  buoyant  in  spirit  and  hopeful  of  the 
best  possible  result. 

The  nurse  should  be  a  quiet,  orderly  woman,  and  neither 
too  young  or  too  old;  she  should  have  had  experience  in 
nursing  during  confinements  and  taking  care  of  newborn 
babies;  with  all  this  she  should  not  be  set  in  her  ways,  but 
should  be  accommodating  and  active,  so  that  she  will  carry 
out  conscientiously  the  instructions  of  the  attending  physi- 
cian. 

The  choice  of  a  physician  should  not  be  delayed  until 
the  last  moment,  but  it  should  be  made  several  months  be- 
fore the  expectation  of  delivery,  and  a  woman  should  never 
engage  a  doctor  for  her  confinement,  unless  she  knows  that 
he  has  had  practical  experience  in  at  least  ten  cases  of  con- 
finement, for  some  of  our  leading  medical  colleges  and  all  of 
the  poor  ones,  graduate  hundreds  of  doctors  each  year  who 
never  attended  a  single  case  of  confinement,  and  some  have, 
even,  never  seen  one;  yet  the  newly  fledged  doctors  are 
turned  loose  upon  the  unsophisticated  communities  to  attend 
women  in  the  most  trying  period  of  their  lives,  and  at  a 

(328) 


WHILE   IN   CHILDBED.  329 

time  when  both  the  experience  and  science  of  her  physician 
should  be  her  sheet  anchor  of  hope.  A  physician  who  is 
not  always  sober,  of  good  moral  character,  and  cleanly  in 
his  habits  and  appearance,  should  never  be  allowed  in  the 
lying-in  chamber,  nor  one  who  is  prating  of  the  many  severe 
confinements  he  has  attended,  or  who  boastingly  speaks  of 
the  number  of  times  it  was  necessary  for  him  to  use  instru- 
ments, for  it  is  quite  likely,  that  the  many  severe  confine- 
ments of  which  he  spoke,  were  either  fictitious  or  due  to  his 
ignorance  of  the  subject,  and  the  frequency  with  wThich 
he  used  instruments  was  owing  to  a  lack  of  patience  on  his 
part  or  to  a  desire  to  be  meddlesome  and  make  himself  of- 
ficious. There  are  a  great  many  medical  gentlemen  who 
are  not  charlatans  in  disguise,  and  these  should  be  singled 
out.  The  pregnant  female  should  have  herself  thoroughly 
washed  and  bathed  just  before  confinement,  and  the  vagina 
should  be  thoroughly  rinsed  out  with  half  a  gallon  of  warm 
water  in  which  a  tablespoonful  of  pulverized  borax  has 
been  dissolved;  this  precaution  will  wash  out  any  infectious 
germs  that  may  cause  inflammation. 

The  bed  in  which  the  confinement  is  to  take  place  should 
be  scrupulously  clean,  and  in  order  to  insure  this,  it  should 
be  made  a  rule  that  the  bedstead  be  taken  apart,  and  taken 
out-of-doors  where  it  is  thoroughly  washed  and  afterwards 
exposed  to  the  purifying  influence  of  the  sun  and  air.  The 
mattress  must  also  be  taken  out  for  a  similar  dusting  and 
cleaning,  and  kept  for  a  time  exposed  to  sun  and  air.  The 
confinement  chamber  should  go  through  the  same  renovat- 
ing ordeal;  the  carpet  of  this  particular  chamber  should  be 
taken  up,  the  floor  thoroughly  scrubbed  and  the  walls  and 
ceiling  washed  off  and  whitened.  It  will  be  better  if  a  few 
clean  mats  or  rugs  can  be  substituted,  and  the  old  carpet 
not  relaid  until  after  the  confinement,  when  the  woman  is 
up  and  around  again.  These  precautions  will  guard  against 
the  possibility  of  infection  and  the  dangers  of  childbed  fever, 
and  the  many  different  phases  of  inflammation  which  are 


330  HOME   TREATMENT. 

the  result  of  carelessness  in  the  details  of  cleanliness.  Of 
course,  the  nurse  and  attending  physician  must  be  equally 
anxious  of  their  own  personal  cleanliness.  If  he  or  she 
leave  any  of  the  infectious  diseases,  like  scarlet  fever,  mea- 
sles, typhoid  fever,  erysipelas  and  puerperal  fever,  either  of 
them  is  quite  sure  to  communicate  the  contagion  to  the  in- 
nocently ignorant  lying-in  woman,  and  entail  upon  her 
endless  suffering  and  death.  In  France  and  Germany, 
stringent  precautions  for  nurse  and  physician  against  the 
dangers  of  infections  are  mandatory  under  the  laws,  but  in 
free  America  such  legal  injunctions  would  be  considered  as 
curtailing  our  liberty;  in  the  meantime,  innocent  lives  are 
sacrificed,  through  lack  of  systematized  regulations,  at  the 
cost  of  liberty  degenerating  into  license. 

On  the  day  of  confinement  the  bed  is  held  in  readiness 
for  the  occasion,  by  spreading  over  the  mattress  a  large 
piece  of  oiled  cloth,  or  what  is  preferable,  rubber  cloth;  this 
must  reach  up  high  enough  so  as  to  afford  proper  protection 
and  lap  over  the  side  of  mattress  and  bedstead.  Beside  the 
bed  an  extra  mat  should  be  laid,  to  catch  any  fluid  that 
may  run  down  the  rubber  cloth  on  the  floor. 

The  preliminary  signs  of  labor  pains  that  make  them- 
selves felt  by  the  pregnant  female,  are  of  considerable  inter- 
est to  her  and  I  believe,  that  if  she  will  familiarize  herself 
with  their  character  she  will  have  less  anxiety  and  more 
confidence  in  a  happy  termination  of  her  condition.  For 
some  days,  and  occasionally  for  two  or  three  weeks  prior  to 
the  commencement  of  actual  labor,  a  sense  of  uneasiness 
about  the  uterus  will  be  felt  by  the  female;  this  uneasiness 
will  be  observed  several  times  during  the  day  and  night. 
When  the  patient  complains  of  this  local  disturbance,  she 
may  feel,  by  placing  her  hands  over  the  region  of  the  womb, 
that  the  organ  becomes  hard  for  the  time  being,  and  as  soon 
as  the  sense  of  uneasiness  passes  away,  the  womb  becomes 
soft  again.  These  symptoms  are  called  the  "independent 
contractions  of  the  uterus"  and  in  the  first  pregnancy  they 


WHILE   IN   CHILDBED.  331 

are  felt  earlier  than  afterwards.  This  is  simply  a  muscular 
irritability  of  the  womb  and  is  not  accompanied  by  "bear- 
ing down"  which  is  the  true  characteristic  of  labor.  These 
preliminary  skirmishes  must  not  be  mistaken  for  the  com- 
mencement of  labor,  otherwise  great  mischief  may  be  done 
by  harassing  the  case  into  a  premature  delivery  which 
might  sacrifice  the  child.  The  pregnant  female  will  often 
become  very  anxious  when  she  first  experiences  these  inde- 
pendent pains  and  she  may  imagine  that  something  is 
wrong;  for  this  apprehension  there  is  no  reason,  because  ex- 
perience has  taught  that  the  greater  this  local  disturbance 
before  the  beginning  of  labor,  the  more  favorable  the  prog- 
ress of  labor  will  be  when  true  labor  pains  set  in. 

"The  righting  of  the  organ"  will  be  observed  for  some 
days  previous  to  the  confinement,  by  a  change  of  the  position 
of  the  pregnant  womb.  The  womb  places  itself,  as  it  were, 
in  readiness  for  the  expulsion  of  the  child,  which  is  shortly 
to  begin.  This  is  done  by  the  body  of  the  uterus  inclining 
forwards  and  sinking  downwards,  and  correspondingly 
relieving  from  pressure  the  organs  of  the  chest ;  this  makes 
breathing  easier,  and  in  proportion  as  the  body  of  the  womb 
comes  down,  so  will  the  lower  portion  of  the  organ  descend, 
and  this  may  give  rise  to  irritation  of  the  bladder  and  fre- 
quent desire  to  pass  water;  sometimes  the  passage  of  urine 
may  be  entirely  obstructed,  so  that  the  water  must  be  drawn 
off  by  means  of  a  catheter.  Some  women  become  very 
nervous  just  before  the  commencement  of  labor;  this  is  gen- 
erally due  to  fear  or  anxiety,  for  which  there  is  no  reason, 
and  agreeable  companionship  will  generally  dispel  all  evil 
forebodings  and  restore  her  to  self-confidence. 

Labor  pains  are  divided  into  true  and  false,  and  this  dis- 
tinction is  entirely  based  upon  their  different  sources. 
True  labor  pains  are  due  to  the  contractions  of  the  muscles 
of  the  uterus,  and  at  the  beginning  they  are  slight  They 
commence  in  the  back  and  run  on  down  to  the  thighs;  one 
feature  about  them  is  that  they  are  intermittent,  that  is, 


332  HOME   TREATMENT. 

that  they  are  not  continuous;  there  is  always  an  interval, 
especially  at  the  beginning  of  labor,  in  which  there  is  no 
pain  at  all.  When  labor  sets  in,  the  pains  are  grinding  or 
cutting,  but  as  soon  as  the  mouth  of  the  uterus  is  fairly 
opened  or  dilated,  the  character  of  the  pain  changes  to  a 
bearing  down  or  forcing  out  nature.  If  the  hand  is  applied 
over  the  region  of  the  womb,  during  the  presence  of  a  pain, 
the  organ  can  be  felt  hardened  and  swollen;  this  subsides 
with  the  pain,  and  in  the  interval,  the  organ  relaxes.  This 
is  a  wise  provision  of  nature,  for  it  gives  the  woman  an  oppor- 
tunity to  recover  and  regain  fresh  strength  for  each  succeed- 
ing effort.  False  labor  pain  has  no  connection  with  the  proc- 
ess of  childbearing,  but  is  only  an  incidental  complication. 
It  may  be  caused  by  gas  in  the  intestines,  indigestion, 
diarrhea,  constipation,  disease  of  the  kidney,  neuralgia,  or 
rheumatism  of  the  muscles  of  the  abdomen  or  bowels,  and 
by  the  passage  of  gallstones;  where  the  false  pains  have  been 
traced  to  their  origin  they  can  be  properly  dealt  with. 

A  muco-sanguineous  discharge  from  the  vagina  is 
another  sign  that  labor  has  begun,  but  it  will  sometimes 
happen  that  it  is  absent,  and  this  constitutes  a  dry  labor.  The 
mucous  discharge  which  is  thus  observed,  subserves  a  very 
important  object  in  lubricating  the  parts  and  relaxing  the 
neck  of  the  womb  and  the  vagina.  There  is  often  a  slight 
tinge  of  blood,  due,  perhaps,  to  a  rupture  of  small  blood  ves- 
sels in  the  mouth  of  the  womb;  this  is  called  a  show,  which 
some  women  have  for  several  days  before  labor  commences. 
"  Stages  of  labor"  are  arbitrary  divisions,  so  as  to  simplify 
the  explanation  of  the  entire  process  of  labor  from  the  time 
the  womb  begins  to  act,  up  to  the  last  act  of  parturition, 
which  is  the  expulsion  of  the  afterbirth,  and  these  have 
usually  been  divided  into  three  stages.  The  first  stage  is 
the  dilation  or  opening  of  the  mouth  of  the  womb,  includ- 
ing also  the  breaking  of  the  membraneous  sac  which  holds 
the  fluid  in  which  the  child  floats,  so  as  to  protect  it  from 
pressure  that  the  walls  of  the  uterus  would  be  continually 


WHILE   IN   CHILDBED.  333 

exercising,  which  would  prevent  its  proper  development. 
In  this  stage  the  woman  should  not  exert  herself  by  bearing 
down;  this  will  only  waste  her  strength  which  she  should 
preserve  for  the  second  stage,  when  the  mouth  of  the  womb 
has  opened  and  the  progress  of  the  child  into  the  world  has 
commenced ;  during  this  stage,  the  female  should  make  an 
attempt  to  relieve  her  bladder,  and  if  she  has  had  no  stool 
for  several  hours  before,  it  will  be  a  good  thing  to  use  an 
enema  of  warm  water,  and  empty  the  bowels. 

The  second  stage  of  labor  begins  when  the  bag  of  water 
has  broken  and  the  waters  escape;  the  contractions  of  the 
womb  increase  now  in  violence  and  become  decidedly  of  a 
bearing  down  character.  At  this  period  the  patient  should 
be  furnished  with  something  that  she  may  grasp  with  her 
hands;  a  sheet  attached  to  the  post  of  the  bed  is  the  best  for 
this  purpose,  and  with  her  feet  steadily  braced,  holding  her 
breath  she  bears  down  whenever  a  pain  comes  on ;  bearing 
down  between  pains,  only  exhausts  the  patient  and  does  no 
good.  During  this  stage  of  labor,  the  pain  in  the  patient's 
back  will  sometimes  become  intense,  she  exclaims :  Oh,  dear, 
doctor,  my  poor  back  feels  like  breaking!  what  shall  I  do? 
The  greatest  relief  that  can  be  given  at  this  time  is  to  sup- 
port the  back  with  the  flat  surface  of  the  hand,  or  by  fold- 
ing a  towel  and  placing  it  under  the  back,  the  two  ends 
being  held  by  assistants. 

As  the  birth  of  the  child  progresses  and  it  approaches  the 
vulva,  the  patient  will  feel  an  urgent  inclination  to  go  to 
stool;  upon  this  she  must  not  insist,  for  at  this  advanced 
period  of  labor  she  may  injure  herself  and  child.  The 
desire  is  caused  by  the  pressure  of  the  child's  head  against 
the  rectum ;  any  fecal  matter  that  is  thus  pressed  out  should 
be  at  once  removed  by  the  nurse. 

The  third  stage  of  labor  consists  in  the  expulsion  of  the 
placenta  or  afterbirth. 

There  is  a  natural  detachment  of  the  placenta  and  a  nat- 
ural expulsion,  but  one  must  have   the  patience  to  wait. 


334  HOME    TREATMENT. 

What  presumption  of  the  officious  doctor  or  midwife  to  sup- 
pose that  nature  was  so  derelict  as  to  require  some  meddle- 
some assistant,  immediately  after  the  birth  of  the  child,  to 
drag  or  pull  on  the  placenta:  no,  more  than  that,  carry  the 
hand  up  into  the  cavity  of  the  womb  and  detach  the  placenta 
with  the  fingers  and  bring  it  down  and  out.  When  I  first 
started  out  to  practice  I  was  foolish  enough  to  believe  and 
do  the  same  thing,  and  afterwards  I  congratulated  myself 
how  wonderfully  skilled  I  was,  but  now  I  am  convinced  that 
this  procedure  was  due  to  ignorance  of  the  laws  of  nature. 
The  truth  of  the  matter  is,  that  the  sooner  and  the  more  one 
pulls  and  feels  on  the  placenta,  the  more  irritable  the  womb 
becomes,  and  the  more  will  the  uterus  contract,  as  though  it 
protested  against  interference. 

I  have  had  it  happen,  and  others  must  have  had  the  same 
experience,  that  the  womb  closes  and  contracts  firmly  in  ten 
to  twenty  minutes  after  delivery,  the  afterbirth  becoming 
tightly  inclosed  so  that  one  not  experienced  would  be  fright- 
ened into  the  belief,  Oh !  here  the  placenta  has  grown  to  the 
womb.  This  is  a  delusion  which  may  lead  to  an  interfer- 
ence that  may  entail  dangerous  consequences  to  the  mother. 
The  condition  is  simply  this,  that  as  the  afterbirth  was  not 
completely  detached  at  the  birth  of  the  child,  the  uterus  con- 
tracted immediately  upon  and  around  the  retained  placenta, 
and  for  two  physiological  reasons:  (1)  to  accomplish  the  very 
object  which  was  imagined  was  not  accomplished,  namely, 
by  contracting,  the  uterus  naturally  peels  itself  off  from  the 
placental  attachment,  and  (2)  were  it  not  for  this  immediate 
contraction  of  the  uterus  after  the  expulsion  of  the  child, 
the  mother  would  likely  flood  from  the  uterine  vessels  of  the 
partly  detached  placenta.  Of  late  years  I  never  experienced 
a  single  case  in  which  the  placenta  did  not  detach  itself,  and 
if  I  had  known  twenty  years  ago  as  I  do  now,  I  never  would 
have  had  one. 

After  the  delivery  of  the  child,  the  woman  should  be 
made  as  comfortable  as   possible  for  the  time  being,  and 


WHILE    IN    CHILDBED.  335 

by  the  time  the  child  is  washed  and  dressed,  the  placenta 
will  generally  present  itself  in  the  vulva.  If  the  afterbirth 
has  not  come  away  at  once  there  is  no  need  to  become 
alarmed.  I  have  waited  for  six  to  eight  hours  for  that  event 
to  take  place,  and  if  there  is  delay  over  an  hour,  two  tea- 
spoonfuls  of  fluid  extract  of  ergot  will  so  excite  contractions 
of  the  womb  that  its  contents  will  be  expelled. 

Whether  the  afterbirth  comes  away  immediately  after  the 
birth  of  the  child,  or  is  delayed,  it  must  not  interfere  with  put- 
ting the  mother  in  a  warm,  dry,  comfortable  condition. 
Everything  that  is  damp  from  perspiration  or  wet  from  the 
waters,  both  dress  and  bed  linen  must  be  removed  and  re- 
placed with  warmed,  dry,  clean  linen;  this  insures  against 
taking  cold.  To  me  it  looks  like  a  crime  against  science  and 
nature  to  allow  a  woman  to  remain  in  the  wet  and  soiled  bed 
after  her  confinement  for  twelve  or  more  hours,  and  the  doc- 
tor or  nurse  who  permits  this,  is  ignorant  and  negligent  of 
his  duties. 

After  the  placenta  is  removed,  the  binder  or  bandage  is 
applied;  this  is  simply  a  piece  of  unbleached  muslin  about 
eighteen  inches  wide  and  long  enough  to  reach  one  and  a 
half  times  around  the  body;  it  should  be  brought  down  to 
cover  the  hips  and  then  fastened  with  strong  safety  pins. 
The  object  of  the  binder  is  to  give  support  to  the  flabby  and 
relaxed  abdominal  muscles,  which  is  a  great  comfort  and  aid 
to  restore  the  muscles  to  their  former  shape. 

How  a  woman  should  lie  after  confinement  is  of  much 
greater  importance  than  how  she  should  lie  during  child- 
birth ;  in  fact  it  does  not  matter  much  how  she  lies  during 
labor  so  long  as  she  feels  comfortable,  but  after  confinement 
and  during  her  convalescence,  her  position  in  bed  has  an 
important  bearing  on  her  recovery;  to  avoid  repetition  I  refer 
the  reader  to  pages  73  and  250  of  this  work.  Vaginal 
douches  of  hot  water,  of  a  temperature  of  104  degrees  F.  serve 
a  very  useful  purpose  in  washing  out  the  secretions  that 
will  naturally  accumulate  in  the  vagina,  and  after  a  short 


336  HOME   TREATMENT. 

time  undergo  septic  decomposition  ;  these  rinsings  also  assist 
nature  to  repair  and  heal  the  tissues.  The  quantity  of  fluid 
that  should  be  used  at  once  is  half  a  gallon  of  water  in  which 
a  tablespoonful  of  powdered  borax  has  been  dissolved. 
Great  care  should  be  exercised  by  the  nurse,  lest  the  bed 
and  linen  of  the  patient  get  wet,  and  through  this  she  become 
liable  to  take  cold.  The  second  day  after  the  delivery  is 
about  the  right  time  to  begin  using  the  douche,  and  about 
this  time  the  mother  should  also  get  a  mild  laxative,  either 
of  castor  oil  or  of  Femina  laxative  syrup,  which  is  very  pala- 
table and  suitable  for  the  occasion. 

The  last  throes  of  labor  which  usher  the  child  into  the 
world  constitute  the  climax  of  the  parturient  effort  and  as 
there  is  little  or  no  interval  between  the  pains,  the  pains 
at  this  period  have  been  appropriately  termed  double  labor 
pains.  There  is  more  or  less  excitement  and  apprehension 
on  the  part  of  the  lying-in  female  and  the  experienced  prac- 
titioner or  nurse  will  concentrate  his  effort  to  calm  and  en- 
courage the  sufferer  in  the  last  minutes  of  her  travail. 

It  is  best  to  wait  a  few  minutes  after  the  child  is  born 
before  tying  the  cord,  so  as  to  give  the  circulation  time  to 
equalize  itself;  especially  is  this  desirable  when  the  cord  was 
wound  around  the  child's  neck  or  when  it  is  otherwise  com- 
pressed. The  cord  is  tied  about  an  inch  above  the  navel, 
and  half  an  inch  higher  the  cord  is  cut  with  a  pair  of  sharp 
scissors.  In  the  meantime,  the  nurse,  if  properly  instructed, 
will  have  in  readiness  on  the  side  of  the  bed  a  warm  flannel 
or  blanket  which  is  to  receive  the  little  stranger.  There  is 
a  proper  way  to  pick  up  a  newborn  babe,  so  that  it  will  not 
roll  or  slip  from  the  hands,  which  I  have  known  to  happen. 
The  little  baby  must  be  taken  hold  off  with  the  same  gentle 
firmness  as  an  older  child.  To  prevent  any  accident,  place 
the  posterior  surface  of  the  child's  neck  in  the  space  bounded 
by  the  thumb  and  index  finger  of  one  hand,  and  with  the 
other  hand  gently  seize  the  thighs  and  in  this  manner  place 
it  into  the  blanket,  to  be  conveyed  to  a  warm  place  of  safety, 


WHILE   IN   CHILDBED.  337 

— the  newborn  child  must  be  kept  warm,  for  its  very  life 
may  depend  upon  it.  After  the  mother  has  had  her  tempo- 
rary wants  satisfied,  the  nurse  prepares  for  the  first  toilet  of  the 
child. 

The  care  of  the  baby  is  differently  understood  by  differ- 
ent persons,  and  as  a  result  of  this  difference  of  opinion  I 
have  observed  a  great  many  unfortunate  consequences. 
There  is  no  reason  why  the  care  of  the  baby  should  be  resigned 
to  custom  and  habit  for  both  are  often  extremely  hazardous 
to  the  life  of  the  child,  and  this  I  will  illustrate  in  the  course 
of  my  remarks. 

How  often  are  newly  born  infants  taken  into  a  cold  room 
in  which,  from  the  arrangement  of  the  doors,  a  draft  sweeps 
through  whenever  a  person  goes  out  or  comes  in?  How  the 
child  is  laid  bare  in  readiness  for  the  ordeal  of  a  thorough 
cleaning!  The  child  is  generally  first  rubbed  with  oil  and 
afterwards  put  into  a  bath  tub  or  some  other  vessel  of  suffi- 
cient capacity  to  drown  several  babies  at  once.  It  is  now 
treated  to  a  soaping  process,  after  which,  by  means  of  a 
cloth  indifferently  selected,  the  child  is  scrubbed  with  an 
ambition  which  would  have  been  laudable  if  applied  to  the 
nurse's  own  person,  but  why  this  little  innocent  should  be 
the  object  of  such  abuse  has  been  a  standing  wonder  to  me 
from  the  time  I  witnessed  the  first  outrage.  By  the  time  the 
nurse  gets  through  bathing  the  child,  it  is  shivering  and 
blue  from  cold.  I  had  not  been  practicing  medicine  very 
long  before  I  became  appalled  by  this  barbarous  procedure, 
nor  had  I  practiced  very  long  before  I  was  called  upon  to 
sign  a  number  of  death  certificates  of  infants  who  contracted 
colds  that  resulted  in  bronchitis,  pneumonia  and  congestion 
of  the  lungs,  which  caused  their  death. 

There  is  no  sense  in  this  dousing  and  soaping  of  a  new- 
born child,  and  aside  from  its  danger  by  undue  exposure,  it 
is  absolutely  useless.  But  habit  is  often  so  thoroughly  in- 
trenched that  the  good  judgment  which  persons  exercise  in 
most  of  their  duties  may  become  entirely  suspended,  when 
22 


338  HOME   TREATMENT. 

this  force  of  habit  has  established  a  custom  that  is  well-nigh 
universal. 

My  method  of  directing  the  first  toilet  of  the  baby  is 
without  the  possible  dangers  to  which  I  have  referred,  for  it 
has  for  its  object  not  only  to  clean  the  child,  but  to  dress 
it  as  quickly  as  possible  and  again  wrap  it  in  flannel. 
Warmth  is  the  life  of  the  newborn  babe;  it  does  not  re- 
quire much  food,  if  any,  the  first  twenty-four  or  forty-eight 
hours  of  its  life,  but  it  requires  to  be  kept  warm.  The  room 
in  which  the  child  is  to  be  cleansed  must  be  warm  and  free 
from  draft,  and  if  there  is  a  fire  in  the  chamber  where  the 
mother  is,  the  toilet  of  the  child  had  better  be  made  here 
under  her  eyes  and  those  of  the  physician.  The  nurse  or 
person  delegated  to  dress  the  baby  provides  herself  with  a 
vase  or  bowl  of  warm  water  and  a  saucerful  of  warm  olive 
oil  or  vaseline  and  a  few  soft  cloths.  She  then  seats  herself 
in  a  low  chair,  and  by  means  of  a  small  piece  of  flannel  she 
applies  the  oil  all  over  the  baby's  body,  rubbing  in  an  extra 
quantity  in  the  armpits,  groins  and  other  places  where  the 
cheesy  substance  is  thickest.  When  the  oil  has  softened  the 
sebaceous  material,  take  a  soft  muslin  cloth,  provided  for 
the  purpose,  and  beginning  on  the  head  the  oil  is  wiped  off 
again;  where  there  are  blood  stains  left,  wash  these  off  with 
a  soft  flannel  cloth ;  at  the  same  time  the  eyes  are  to  be  bathed 
and  the  mouth  washed  out.  I  have  not  mentioned  the  use 
of  soap,  for  the  reason  that  it  is  not  at  all  necessary  and  very 
often  injurious.  The  oil  removes  all  the  caseous  matter  and 
what  oil  remains  is  rather  an  advantage  than  otherwise; 
it  preserves  the  warmth  of  the  child  and  protects  its  skin. 
If  the  soap  comes  in  contact  with  the  eyes  of  the  infant  it 
often  becomes  a  fruitful  source  of  that  annoying  and  often 
dangerous  disease  of  the  eyes  that  is  technically  termed 
'purulent  ophthalmia. 

Never  apply  oil  or  any  other  greasy  substance  to  the 
cord  before  it  comes  off,  for  this  will  prevent  its  drying  and 
delay   its  falling  off.     When  the  cord  has   come  off,  you 


WHILE   IN   CHILDBED.  339 

simply  keep  the  navel  clean  by  washing  it  daily  with  a  little 
warm  borax  water  and  afterwards  apply  a  small  compress  on 
which  has  been  smeared  a  little  zinc  ointment.  Always  see 
to  it  that  the  baby  is  lying  dry  and  use  dusting  powder 
freely;  the  precipitated  chalk  is  the  best  and  cheapest  infant 
powder  that  can  be  used.  The  child  that  is  nursed  on  its 
mother's  breasts  has  little  to  fear  from  overfeeding,  yet  it 
should  not  be  allowed  to  hang  on  the  nipple  too  long  or 
sleep  witli  the  nipple  in  its  mouth.  Nurse  the  child  every 
two  hours  during  the  day  and  awaken  it  if  it  should  sleep 
to  give  it  its  nourishment,  but  at  night  allow  it  to  sleep  as 
long  as  it  wants  to;  this  will  cultivate  regular  habits  in  the 
child  and  it  will  thrive  much  better.  If  the  baby  cries  and 
is  restless  between  times  do  not  imagine  that  it  is  always 
hungry,  but  rather  colicky,  for  which  there  is  nothing  better 
than  the  old  German  domestic  remedy,  fennel  seed  tea;  of  this 
give  the  baby  all  it  will  drink  every  day  and  until  it  is  a 
year  old. 

Sore  nipples  are  a  great  annoyance  to  a  mother  and  often 
very  obstinate  to  treatment.  The  skin  covering  the  nipple 
is  made  exeedingly  tender  by  the  sucking  of  the  child's 
mouth  and  in  a  few  days  it  cracks  and  becomes  fissured. 
Sometimes,  the  pain  that  the  mother  endures  whenever  the 
infant  nurses  is  excruciating,  for  every  time  the  child  is  put 
to  the  breasts  the  cracks  open  anew.  The  most  fruitful  cause 
of  this  condition  is  to  allow  the  child  to  hold  the  nipple  in 
its  mouth  when  it  does  not  nurse  or  perhaps  to  allow  it  to 
retain  the  nipple  in  its  mouth  while  it  sleeps. 

This  practice  must  be  at  once  discontinued,  and  the  child 
must  be  at  once  removed  from  the  breast  as  soon  as  it  is 
satisfied.  The  nipples  should  be  washed  with  borax  water, 
and  then  a  salve  should  be  made  by  mixing  the  }Tellow  of 
one  egg  with  half  an  ounce  of  Peruvian  balsam.  This  is  to 
be  applied  by  means  of  a  camel's  hair  brush  to  the  sore 
nipple  every  time  after  the  child  is  through  nursing.  Should 
the  nipple  be  too  sensitive  and  the  suction  of  the  child  too 


340  HOME    TREATMENT. 

painful,  then  a  breast  pump  had  better  be  used  for  a  few 
days  and  the  child  not  applied  until  the  teat  has  sufficiently- 
improved. 

Abscess  of  the  breast  constitutes  a  distressing  compli- 
cation of  the  puerperal  condition,  inflicting  upon  the  pa- 
tient intense  suffering,  and  very  often  leading  to  a  long 
delay  in  recovery.  It  may  be  due  to  cold,  and  in  one  case  it 
developed  from  this  cause  two  months  before  confinement, 
but  this  is  an  exception.  Sore  nipples  are  a  fruitful  cause, 
for  the  soreness  of  nursing  makes  the  mother  reluctant  to 
have  the  child  draw  all  the  milk  out,  hence,  the  breast 
cakes  and  hardens  with  the  above  result.  It  also  is  due  to 
neglect  in  not  having  the  nipple  properly  drawn  out;  or  to 
a  foolish  custom,  derived  from  remote  ancestry  not  to  allow 
the  infant  to  be  put  to  the  breast  for  two  or  three  days  after 
its  birth.  In  this  way  the  milk  ducts  become  greatly  dis- 
tended, inflammation  sets  in,  which,  if  not  properly  arrested 
will  terminate  in  an  abscess.  If  gentle  friction  of  cam- 
phorated oil  and  hot,  moist  compresses  or  poultices  do  not 
enable  the  child  to  draw  out  the  secretion,  a  young  pup 
should  be  obtained,  for  he  draws  with  a  gentleness  and  ac- 
tivity which  surpasses  the  most  perfect  machine.  The 
patient  must  drink  sparingly  of  fluids  and  properly  support 
the  breasts  by  means  of  handkerchiefs  placed  under  them 
and  made  to  cross  the  shoulders,  and  the  bowels  should 
be  thoroughly  opened.  Should  an  abscess  form  it  should 
be  opened  by  a  free  incision,  and  the  poultice  discontinued, 
but  instead  a  wad  of  absorbent  cotton  should  be  applied  and 
the  breast  tightly  bandaged  with  the  handkerchief. 


CHAPTER  XXIX. 

DISEASES  PECULIAR  TO  CHILDREN. 

The  diseases  of  children  that  I  propose  to  inquire  into, 
are  not  those  of  so  serious  a  nature  as  to  require  the  skill  of 
a  physician,  but  rather  those  trivial  ailments  which  are 
common  among  children  of  tender  age  and  which  neither 
good  care  nor  healthy  surroundings  seem  to.be  able  to  ward 
off.  And  for  this  reason,  mothers  and  nurses  should  famil- 
iarize themselves  with  these  ailments  and  their  appropriate 
treatment,  for  trivial  as  they  may  seem  to  begin  with,  if 
permitted  to  go  on  uncontrolled,  they  often  lead  to  more 
serious  and  perhaps  fatal  consequences. 

A  coated  tongue  in  children  is  not  always  a  sign  of 
digestive  disturbance,  for  most  nurslings  have  a  white  coated 
tongue  in  the  first  three  or  four  weeks  of  their  lives.  With 
the  ancients,  and  even  up  to  within  a  recent  period,  the 
tongue  was  considered  the  mirror  of  the  stomach;  this  was  a 
delusion  because  nothing  definite  or  of  great  importance  can 
be  deciphered  in  any  case  from  the  appearance  of  the  tongue 
alone,  but  this  superstition  became  so  deeply  rooted  in  the 
minds  of  the  public,  that  even  now  a  medical  examination 
is  considered  incomplete  unless  the  physician  says  put  your 
tongue  out,  for  the  purpose  of  a  physical  inspection. 

When  the  child  loses  its  appetite  and  the  stomach  and 
bowels  become  deranged,  the  tongue  generally  becomes 
coated.  Children  who  are  overfed  and  in  whom  the  food 
is  not  digested,  may  have  a  thick  fur  over  the  tongue,  but 
as  a  rule  only  on  the  back  of  the  tongue  there  is  a  whitish 
coat.  In  diseases  of  the  mouth  that  are  purely  local,  the 
tongue  is  sometimes  coated,  quite  independently  of  any  disease 

"  (341  ) 


342  HOME    TREATMENT. 

of  the  stomach,  as  for  instance  in  thrush,  in  catarrhal  inflam- 
mation of  the  mouth,  diphtheria,  burns  and  other  injuries. 

(a)  Catarrh  of  the  mouth  is  an  .inflammation  of  the  mu- 
cous membrane  and  is  recognized  by  redness  and  increased 
secretion.  It  is  most  intense  on  the  tongue,  which  presents 
the  appearance  as  though  it  were  coated  with  raspberry 
syrup.  Sometimes  the  redness  is  most  on  the  inside  of  the 
cheeks  and  soft  palate,  while  the  tongue  is  covered  with  soft 
fur.  The  inflammation  of  the  mucous  membrane  of  the 
mouth,  extends  in  aggravated  cases  to  the  throat  and  nasal 
passages  and  along  the  Eustachian  tube  into  the  ear.  There 
is  many  a  baby  suffering,  no  one  knows  from  what,  when  it 
has  an  earache  due  to  this  cause.  When  the  catarrh  has 
existed  for  some  time,  clear,  minute  water-vesicles  rise  upon 
the  tongue,  gums  and  mucous  membrane  of  the  lips  and 
cheeks.  These  burst  and  leave  behind  them  small, flat  ulcers, 
which  in  the  first  few  days  run  together  and  present  large, 
flat,  ulcerated  surfaces.  The  children  become  feverish  and 
refuse  to  eat  and  drink  for  days,  partly  because  to  do  so,  pains 
them  and  partly  from  a  loss  of  appetite. 

The  most  common  cause  is  the  eruption  of  the  teeth. 
Mothers  of  experience  know  that  when  the  baby  drools,  it  is 
teething,  and  if  she  examines  a  little  closer  she  will  discover 
the  catarrhal  condition  described.  Another  cause  is  the  old- 
fashioned  sugar  teat  with  its  souring  contents;  so  is  the 
nursing  food,  when  either  too  hot  or  too  cold,  and  in  older 
children  irregular  or  improper  food  has  the  same  effect,  for 
instance,  sour  ripe  fruit  eaten  in  excess. 

The  treatment  for  catarrh  of  the  mouth  is  simple  and 
successful  if  directed  to  the  removal  of  the  causes  that  we 
have  enumerated.  The  mouth  should  be  cleansed  every  few 
hours  with  a  little  borax  water,  and  the  febrile  symptoms 
generally  subside  with  a  dose  of  mild  laxative. 

(6)  Putrid  sore  mouth  is  an  aggravated  stage  of  the  above 
affection;  it  begins  on  the  borders  of  the  gums  as  inflamed 
patches  coated  with  a  thin  layer  of    yellow  mucus.     The 


DISEASES   OF   CHILDREN.  343 

slightest  touch  of  the  ulcerated  places  causes  bleeding,  and 
the  affection  can  be  recognized  at  quite  a  distance  from  the 
mouth  by  the  sense  of  smell.  The  disease  is  contagious  and 
may  be  imparted  from  one  child  to  another.  Carious  teeth 
are  the  predisposing  agents;  mercury  or  calomel  in  repeated 
and  large  doses  produces  a  similar  effect.  A  very  simple 
and  efficient  remedy  for  this  affection  is  a  saturated  solution 
of  chlorate  of  potassa,  in  the  proportion  of  a  teaspoonful  to  a 
teacupful  of  boiling  water;  with  this  solution  wash  the  mouth 
out  every  two  hours,  and  allow  a  little  to  be  swallowed  at  the 
same  time;  children  under  one  year  of  age  can  swallow  ten 
drops;  under  two  years,  twenty  drops;  under  three,  thirty 
drops,  and  larger  ones  can  take  a  teaspoonful. 

(c)  Thrush,  sprue,  or  soor  is  another  type  of  sore  mouth 
that  falls  to  the  lot  of  some  children.  It  resembles 
catarrh  of  the  mouth,  but  must4be  considered  a  different 
disease,  inasmuch  that  it  is  proven  to  be  due  to  a  fungus 
growth.  The  disease  begins  with  a  change  of  color  from  the 
natural  bright  red,  to  a  livid,  dark  red  color;  the  entire 
mucous  membrane  of  the  mouth  is  uniformly  discolored ; 
the  discoloration  never  occurs  in  spots,  and  the  surface  pre- 
sents the  appearance  as  if  a  thick  coat  of  raspberry  syrup 
had  been  smeared  upon  it.  The  mucous  membrane  becomes 
dry  and  sticky  and  the  secretion  of  the  mouth  is  acid.  On 
inspecting  the  mouth  the  fungi  can  be  seen,  at  first  as  small 
white  points  if  only  existing  a  few  hours,  but  their  growth 
is  very  rapid,  and  they  soon  form  large  white  patches,  which 
may  run  together  and  cover  the  entire  mouth.  The  treat- 
ment is  directed  towards  removing  the  cause  in  the  first 
place;  if  the  child  has  been  using  the  sugar  teat  that  must 
be  discontinued,  and  even  a  milk  diet  should  be  suspended 
for  a  few  days,  on  account  of  its  containing  sugar  and  cheesy 
matter,  and  instead  the  child  should  be  fed  with  a  little 
thickening  of  arrow  root  or  wheaten  flour.  The  mouth 
must  be  kept  sweet  and  clean  with  a  solution  of  borax 
applied  with  a  small  camel's  hair  brush;  if  the  disease  is 


344  HOME   TREATMENT. 

obstinate,  dissolve  the  borax  in  creosote  water  obtained  from 
a  druggist,  and  apply  this  every  hour  or  two  as  above. 

(d)  Parotitis,  or  mumps,  is  an  inflammation  of  the  parotid 
or  salivary  gland.  The  disease  shows  itself  as  a  swelling 
between  the  angle  of  the  lower  jaw  and  the  ear.  Several 
days  before  the  swelling  and  pain  begin,  the  children  feel 
tired,  ill-humored,  feverish,  lose  their  appetite,  lounge  around 
or  voluntaril}'-  take  to  bed.  Nervous  children  show  brain 
symptoms;  they  complain  of  headache,  are  delirious  and 
have  convulsions.  After  two  or  three  days  they  begin  to 
feel  pain  behind  the  jaw,  and  when  they  open  the  mouth, 
masticate,  or  on  slight  pressure,  the  pain  becomes  aggravated. 
The  swelling  over  the  corresponding  cheek  extends  to  the 
lower  eyelid  and  back  to  the  neck.  The  skin  over  the  swell- 
ing becomes  inflamed  and  red.  In  males  the  swelling  may 
suddenly  move  from  the  neck  to  the  testes,  while  in  the 
female  it  may  strike  on  the  mammae. 

The  course  of  mumps  is  usually  favorable,  but  there  is  a 
possibility  of  an  abscess  forming,  and  this  may  break  di- 
rectly outward,  or  burrow  backwards  and  burst  into  the  ear, 
perforating  the  ear  drum,  causing  lifelong  deafness.  I  have 
had  one  case  in  which  the  disease  went  to  the  brain ;  the 
little  boy,  a  child  of  seven,  died.  The  patient  who  has 
mumps  must  be  kept  warm;  over  the  swelling  apply  hot 
poultices  for  three  or  four  days,  and  besides  wrap  the  entire 
head  and  neck  in  flannel.  If  the  swelling  is  painful,  and 
the  child  in  robust  health,  a  few  leeches  applied  to  the  swell- 
ing will  relieve  the  pain  and  have  a  good  effect  on  the  cause 
of  the  disease.  Belladonna  ointment  is  a  valuable  remedy 
for  older  children,  but  with  babies  it  must  be  used  with  ex- 
treme care.  The  diet  must  be  bland  and  light;  bread  and 
milk,  or  gruel,  is  the  most  appropriate.  Give  a  little  paregoric 
at  night  to  soothe  the  restlessness,  and  open  the  bowels  with 
the  Femina  laxative  syrup. 

(e)  Tonsilitis  or  quinsy  sore  throat  is  often  mistaken 
for  the  mumps,  but  to  the  experienced  practitioner  or  nurse 


DISEASES   OF   CHILDREN.  345 

there  is  no  resemblance,  and  to  mistake  one  for  the  other  is 
almost  impossible.  In  tonsilitis  the  cheek  never  swells,  the 
swelled  tonsils  being  felt  only  behind  the  jaw  and  quite  below 
the  ear.  Tonsilitis  occurs  oftener  than  mumps,  and  unlike 
the  latter  affection,  when  the  patient  has  had  one  attack  of 
quinsy  he  is  likely  to  have  a  recurrence  whenever  he  gets  a 
fresh  cold.  The  disease  begins  with  difficult  deglutition, 
pain,  heat  and  dryness  in  the  throat,  and  always  more  or 
less  fever,  from  which  some  children  become  quite  delirious. 
The  affected  tonsils  become  as  large  as  pigeon  eggs,  and 
can  be  readily  felt  beneath  the  angle  of  the  lower  jaw.  The 
swollen  tonsils  are  red  and  dotted  with  yellowish  spotsi 
which  is  due  to  the  suppuration  of  the  follicles  of  which  the 
gland  is  composed.  If  both  swell  at  the  same  time  so  that 
they  touch  each  other,  symptoms  of  suffocation  may  ensue. 
The  writer  suffered  from  tonsilitis  when  he  was  a  student, 
and  the  pain  was  indeed  excruciating  for  a  time.  The  pain 
is  sometimes  greater  in  swallowing  fluids  than  solids.  In 
examining  the  mouth  a  little  skill  is  required.  Some  chil- 
dren are  so  well  trained  that  they  will  respond  at  once,  and 
then  by  means  of  a  spoon  handle  the  tongue  is  depressed, 
and  the  tonsils  come  into  view.  Others  again  have  their  own 
sweet  will  about  these  things,  and  simply  will  not  voluntarily 
open  their  mouths.  Then  it  takes  two  persons  to  manage 
them  in  the  following  manner:  while  one  person  holds  the 
child  in  his  lap,  its  back  and  head  braced  against  his  chest 
and  the  hands  held  down,  the  other  person  slides  the  handle 
of  a  teaspoon  along  the  tongue  until  he  touches  the  soft  palate; 
this  makes  the  child  gag,  and  at  that  moment  the  tonsils  are 
brought  plainly  into  view. 

The  treatment  for  tonsilitis  should  be  prompt  and  active; 
that  is,  when  the  disease  is  recognized,  something  should  be 
done  at  once  to  relieve  it.  If  the  bowels  are  constipated 
give  a  laxative  at  once,  and  over  the  painful  tonsils  apply  a 
flaxseed  poultice,  keeping  the  neck  and  head  wrapped  up 
well  at  the  same  time.    For  the  fever  give  a  dose  of  antifebrine 


340  HOME   TREATMENT. 

in  the  forenoon  and  at  bedtime;  for  a  child  one  year  old,  one 
grain  for  a  dose ;  at  the  age  of  three  or  four,  give  two  grains 
at  once,  and  at  eight  to  twelve  years,  three  grains  can  be 
given.  Chlorate  of  potassa  is  the  best  remedy  for  a  gargle, 
and  for  internal  use  also.  Make  a  solution  of  chlorate  of 
potassa  by  dissolving  one  teaspoonful  in  a  teacupful  of  hot 
water,  and  when  cooled  off,  have  the  child  gargle  every  hour 
or  two,  and  swallow  a  half  to  a  teaspoonful  of  the  solution 
at  the  same  time. 

(/)  Diphtheria  of  the  throat  is  eminently  an  epidemic 
disease  and  of  a  highly  contagious  and  infectious  nature. 
Of  late  years,  the  disease  occurs  in  every  season  of  the  year, 
and  independently  of  any  epidemic  or  contagious  influence, 
but  it  is  presumed  that  the  contagion  or  spores  are  cultivated 
in  improper  sanitary  conditions  arising  from  defective  sew- 
erage and  filthy  accumulations.  The  disease  invariably  be- 
gins with  fever,  a  marked  increase  of  the  pulse,  increase  of 
the  temperature  of  the  skin,  and  general  depression.  There 
is  first  a  difficulty  of  swallowing,  a  snuffling  voice  and  stiff- 
ness in  the  neck;  the  first  two  signs  are  due  to  the  swelling 
and  diphtheritic  coating  of  the  tonsils,  palate  and  nasal 
passages,  while  the  last  symptom  is  due  to  a  swelling  of  the 
lymphatic  glands  of  the  neck  which  is  never  absent  in  gen- 
uine diphtheria.  If  the  throat  is  examined  in  the  earl}r 
stage,  the  white  membrane  is  first  seen  in  the  tonsils  and  as 
the  disease  progresses  it  spreads  to  the  palate,  the  pharynx 
and  the  nasal  passages.  The  color  of  the  membrane  also 
changes;  after  several  days  it  passes  into  a  yellowish-white 
or  grayish-white  tint.  It  has  another  peculiar  feature  that 
distinguishes  this  membrane  from  the  exudation  of  ordinary 
tonsilitis,  which  the  practical  eye  at  once  detects;  the  mem- 
brane of  diphtheria  makes  the  impression  of  having  eaten 
into  the  tonsil  or  as  though  it  was  pressed  into  the  tissue  by 
the  finger.  And  that  is  really  so  too,  because  as  a  scientific 
fact  it  is  no  membrane  at  all,  but  a  death  or  slough  of  the 
mucous  membrane  which  may  extend  down  into  the  tissue 


DISEASES   OF    CHILDREN.  347 

beneath  the  membrane.  To  treat  diphtheria  successfully 
is  simple  enough  but  it  requires  great  skill  and  experience, 
and  I  will  outline  what  I  consider  the  proper  thing  to  do 
and  which  in  my  hands  saved  those  lives  that  were  intrusted 
to  my  care. 

The  treatment  resolves  itself  into  perfect  cleanliness  or 
disinfection,  stimulating  nourishment  and  internal  medica- 
tion. 

Everything  must  be  kept  clean  around  the  patient,  and  a 
vessel  must  be  provided,  containing  a  little  chloride  of  lime 
into  which  he  spits  or  hawks  the  phlegm  from  his  throat. 
The  membrane  or  slough  in  the  throat  or  nose  must  be  thor- 
oughly disinfected  and  the  only  evidence  that  this  has  been 
successfully  accomplished  is  when  all  offensive  odor  has  dis- 
appeared. For  this  purpose  as  a  local  application  I  employ 
the  following  preparation:  Solution  of  subsulphate  of  iron 
(Monsel's  solution)  3  drams,  glycerine  5  drams;  mix  and 
pour  ten  to  twenty  drops  into  a  saucer  and  by  means  of  a 
camel's  hair  brush  apply  to  the  diphtheritic  membrane  un- 
til the  character  and  odor  of  it  is  destroyed;  this  application 
repeat  every  four  hours.  Should  the  nasal  passages  be  also 
affected  mix  a  teaspoonful  of  the  preparation  to  a  tea- 
cupful  of  warm  water  and  by  means  of  a  syringe  wash  the 
nasal  passages  out  several  times  a  day.  Give  the  patient 
internal  medicine  to  disinfect  the  stomach  and  for  its  alter- 
ative action  on  the  blood:  for  this  purpose  use  tincture  of 
iron  4  drams,  simple  syrup,  add  to  make  4  ounces.  To  a 
child  seven  to  ten  years  old  give  a  teaspoonful,  ten  or  fifteen 
minutes  each  time,  after  the  brushing.  Between  the  times 
of  brushing  and  giving  the  medicine,  that  is  two  hours 
afterwards,  give  the  nourishment  and  stimulant;  this  consists 
of  milk  punch.  A  child  seven  to  ten  years  old  should  take 
no  less  than  a  tablespoonfulof  whisky,  with  or  without  a  lit- 
tle sugar,  in  a  half  to  a  teacupful  of  milk  beaten  thoroughly 
together  with  an  egg  beater;  this  is  to  be  taken  for  a  meal  and 
drank  at  once,  and  repeated  every  four  hours.     No   other 


348  HOME   TREATMENT. 

food  or  nourishment  must  be  given  for  a  number  of  days, 
and  if  the  child  is  thirsty  between  times  allow  it  to  drink 
sweetened  water  and  whisky.  Sometimes  the  glands  of  the 
neck  and  the  tonsils  swell  and  become  very  painful;  for  this 
the  Belladonna  ointment  applied  with  gentle  friction  night 
and  morning  and  the  neck  enveloped  in  cotton  batting  are 
certain  to  give  relief.  The  efficiency  of  this  treatment  de- 
pends upon  the  intelligence  and  faithfulness  with  which  it 
is  used. 

(g)  Croup  is  a  term  derived  from  the  German  Kropf 
the  crop  or  craw  of  the  bird;  this  disease  is  known  by  a 
great  many  different  names,  but  on  account  of  its  shortness, 
croup  has  received  the  preference.  The  disease  has  to  do 
with  an  affection  of  the  organ  of  the  voice,  the  larynx,  which 
is  the  upper  part  of  the  air  passage,  and  situated  between 
the  trachea  and  base  of  the  tongue  at  the  upper  and  front 
part  of  the  neck  where  it  forms  a  projection  in  the  middle 
line  which  is  prominent  above  and  called  the  pomum 
Adami  or  Adam's  apple.  The  larynx  contains  the  vocal 
cords,  running  from  before  backwards  on  both  sides;  these 
form  the  narrow  fissure  or  chink,  the  rima  glottidis,  through 
which  we  breathe.  Like  all  other  air  passages  this  too  is 
lined  with  mucous  membrane.  The  symptoms  that  fore- 
shadow croup  are  not  particularly  significant,  for  they  sim- 
ply indicate  that  the  child  has  a  cold.  The  children  have 
a  cough,  they  sneeze,  and  their  appetite  is  capricious  for  a 
few  days;  they  are  not  as  lively  as  usual  and  are  more  or 
less  feverish.  In  a  certain  proportion  of  cases  there  is 
nothing  noticeable  before  the  croup  develops,  for  the  chil- 
dren may  go  to  bed  perfectly  well  and  sleep  calmly  the  first 
few  hours  of  the  night,  when  suddenly  they  are  awakened 
with  a  barking  cough,  which  greatly  frightens  young  chil- 
dren and  they  begin  to  cry.  The  cough  may  repeat  itself 
at  short  intervals,  the  voice  become  hoarse  and  husky  and 
lower  and  lower,  so  that  in  the  morning  a  well  marked 
croup  is  developed.     The  voice  finally  disappears  so  com- 


DISEASES   OF   CHILDREN.  349 

pletely  that  it  is  not  heard  above  a  whisper,  and  the  greatest 
pain  and  harassing  symptoms  of  suffocation  do  not  enable 
the  child  to  utter  a  loud  sound.  The  respiration  becomes 
labored  in  proportion  to  the  swelling  of  the  vocal  cords  and 
other  obstructions  to  the  passage  of  air  through  the  larynx. 
Croup  has  vagaries  that  cannot  be  foretold.  One  child  may 
have  symptoms  of  so  threatening  a  nature  that  one  believes 
it  will  suffocate  at  any  moment,  yet,  with  a  few  simple  rem- 
edies, the  symptoms  will  gradually  lessen  and  it  recovers  in 
a  few  days,  while  another  may  be  suffering  comparatively 
little  and  from  appearances  one  would  imagine  that  there  is 
little  or  no  danger,  but  at  once  it  will  change  and  grow 
worse  so  rapidly  that  it  will  die  in  a  few  hours.  For  this 
simple  reason  no  case  of  croup  should  be  carelessly  or  lightly 
considered.  When  a  child  has  croup  it  should  be  put  at 
once  into  a  warm  room  ;  a  big  fire  should  be  kept  up,  and 
the  child  given  hot  drinks  or  a  cupful  of  hot  tea  so  as  to 
make  it  sweat.  The  front  part  of  the  neck  should  be  rubbed 
with  equal  parts  of  turpentine  and  sweet  oil  until  it  feels 
warm  and  the  skin  reddens.  If  the  child  has  eaten  a  good 
supper,  a  teaspoonful  of  syrup  of  ipecac  should  be  given 
every  half  hour  until  it  vomits;  otherwise  vomiting  should  be 
omitted.  The  following  mixture  always  gives  relief  and 
with  other  precautions  is  all  that  is  usually  required. 

Take:  Bicarbonate  of  potassa 2  drams 

Water 1  ounce 

Hive  syrup, 

Paregoric,  of  each J  ounce 

Mix  and  give  half  to  one  teaspoonful  every  two  hours 
until  relieved  ;  then  every  four  to  six  hours. 

What  wehave  considered  thus  far  is  also  called  spasmodic, 
catarrhal  or  false  croup,  to  distinguish  it  from  another  variety 
that  is  described  under  the  name  of  membranous  or  diph- 
theritic croup. 

This  form  of  croup  as  its  name  indicates  is  characterized 
by  a  membrane  which  forms  upon  the  surface  of  the  in- 


350  HOME    TREATMENT. 

flamed  mucous  membrane  of  the  larynx  as  an  exudation, 
and  sometimes  the  croupous  membrane  extends  down  into 
the  windpipe  or  trachea. 

This  variety  of  croup  begins  just  like  the  simple  or 
catarrhal  form  only  as  the  disease  progresses  the  symptoms 
gradually  grow  worse,  and  remain  persistent.  It  is  fortunately 
a  very  rare  disease  and  almost  always  fatal  when  it  does 
occur.  An  ordinary  or  catarrhal  croup  may,  when  neglected, 
run  into  the  membranous  form  and  for  that  reason  children 
who  are  croupous,  no  matter  how  light  it  may  appear,  should 
be  carefully  nursed  until  the  symptoms  have  passed  off. 
The  treatment  for  membranous  croup  has  been  on  the  whole 
very  unsatisfactory;  the  membrane  which  forms  in  the 
larynx  and  windpipe  is  the  cause  of  suffocating  the  child, 
and  the  question  how  to  remove  this  has  never  as  yet  been 
answered.  Of  course  a  great  many  remedies  have  been 
suggested  and  used  but  at  times  all  have  disappointed.  The 
successful  case  of  membranous  croup  that  I  treated  many 
years  ago  was  cured  by  giving  the  little  patient  inhalations 
of  lime  water  with  a  steam  atomizer  and  besides  giving 
whisky  and  milk  as  nourishment;  how  much  of  the  success 
in  this  case  was  due  to  the  child's  vigorous  constitution  and 
how  much  to  the  treatment  will  always  remain  a  mystery. 
In  the  commencement,  the  same  treatment  that  was  recom- 
mended for  false  croup  is  advisable;  later  on  the  skill  of  a 
good  physician  is  required. 

(h)  Bronchitis  or  catarrh  of  the  bronchial  tubes  is  gen- 
erally the  cause  of  the  ordinary  cough  due  to  exposure  or 
taking  cold.  Its  danger  depends  upon  the  severity  of  the 
bronchial  inflammation  and  upon  the  age  of  the  patient; 
the  younger  the  child  the  more  dangerous  the  disease.  In 
older  children  or  adults  there  is  no  connection  between  a 
bronchitis  and  a  pneumonia,  but  in  infants  or  children  un- 
der twro  years  of  age  who  are  suffering  from  bronchitis  the 
tendency  toward  a  complication  with  pneumonia  is  ever 
present;  in  fact,  in  children  of  this  age,  pneumonia  usually 
begins  in  that  way. 


DISEASES   OF   CHILDREN.  351 

Cough  is  the  most  prominent  symptom  and  it  is  always 
present  from  the  commencement  of  the  affection,  and  appre- 
hensive of  this  the  parents  seek  medical  assistance.  The 
expectoration  in  young  children  is  generally  swallowed  after 
each  paroxysm  of  cough,  hence  the  nature  of  it  can  rarely 
be  seen.  In  the  first  part  of  the  night  the  cough  is  always 
more  severe  than  during  the  day,  and  the  paroxysms  may 
last  from  half  to  one  minute,  recurring  several  times  in  the 
hour.  Some  children  are  less  disturbed  in  their  sleep  than 
others,  for  they  sleep  on,  notwithstanding  the  cough,  while 
others  always  awaken,  become  annoyed  from  the  disturbance 
and  cry.  These  interruptions  in  their  night's  rest  reduce 
them  in  strength  and  flesh.  Children  who  cough  more 
when  laid  on  one  or  the  other  side  than  when  they  lie  on 
their  back  and  who  distort  their  face  when  coughing  or,  when 
old  enough,  complain  of  pain  during  or  after  coughing  have 
something  more  than  a  simple  bronchitis ;  they  have  a  com- 
plication of  pleurisy  or  a  pneumonia.  There  is  always  fever 
and  this  may  run  very  high,  so  that  the  child  becomes  delir- 
ious; even  before  the  fever  becomes  very  pronounced  or  the 
cough  very  annoying,  their  little  hands  and  faces  feel  hot  to 
the  touch,  indicating  that  they  are  not  well. 

Infants  require  good  nursing  when  they  are  suffering 
from  bronchitis,  and  it  is  not  good  to  let  them  lie  on  their 
backs  all  of  the  time;  when  they  have  a  coughing  spell  take 
them  up  quickly  and  lay  them  across  the  knees,  with  their 
faces  downwards;  this  gives  the  mucus  a  chance  to  run  out 
of  the  bronchial  tubes  and  mouth  which  is  better  than 
swallowing  it  The  most  important  feature  in  the  treatment 
of  bronchitis  is  a  warm  room  of  even  temperature  night  and 
day.  If  the  temperature  is  allowed  to  go  down  during  the 
night  and  the  child  inhales  cold  air  into  the  lungs  it  will 
often  bring  on  a  relapse  or  aggravate  the  disease.  "When 
children  have  a  cough  and  cold  they  must  be  kept  warm  in 
order  to  get  well ;  this  is  no  time  for  trying  to  harden  them. 
A  thermometer  should  be  in  every  house  and  certainly  in 


352  HOME   TREATMENT. 

every  bedchamber,  so  that  the  temperature  of  a  room  may 
be  gauged  to  a  certainty.  In  ordinary  cases  the  temperature 
should  not  fall  below  seventy  degrees  Fahrenheit,  and  when 
the  child  coughs  very  much  and  the  bronchitis  is  very  bad 
it  is  best  to  keep  the  temperature  of  the  room  around  eighty 
degrees  night  and  day  for  several  days,  and  as  the  patient  im- 
proves, it  is  advisable  to  gradually  drop  to  seventy. 

The  application  of  oil  and  spirits  of  turpentine  is  advisa- 
ble in  all  cases  of  cold  in  the  chest ;  it  does  good  and  one 
can  hardly  explain  how  and  why.  For  the  cough  an  infant 
can  take  with  great  advantage  three  or  four  drops  of  syrup 
of  ipecac  together  with  the  same  amount  of  paregoric, 
every  four  hours;  older  children  take  larger  doses  in  propor- 
tion. When  scrofula  or  tuberculosis  is  at  the  bottom  of  the 
bronchitis,  a  reliable  preparation  of  cod  liver  oil  emulsion 
should  also  be  administered. 

(i)  Pneumonia  is  the  technical  term  for  inflammation  of 
the  lungs  or  lung  fever.  It  consists  of  an  inflammation, 
involving  the  air  cells  and  smallest  air  tubules  of  the  lungs; 
in  other  words,  it  is  an  inflammation  of  the  substance  or 
tissues  of  the  lungs. 

It  is  altogether  a  more  serious  affection  than  bronchitis, 
and  in  very  small  children  exceedingly  dangerous.  The 
inflammation  may  affect  either  a  small  circumscribed  por- 
tion of  the  lung,  lobular  pneumonia,  or  it  may  compromise 
an  entire  lobe  or  all  the  lobes  of  the  lung,  and  is  then 
called  lobar  pneumonia.  Pneumonia  is  dangerous  in  propor- 
tion to  the  extent  of  lung  tissue  involved  and  the  symptoms 
become  correspondingly  aggravated.  The  disease  occurs 
extremely  often  in  children,  but  it  is  altogether  different 
from  that  which  occurs  in  the  adult.  In  children  it  is  of  a 
bronchial  nature,  that  is,  the  ordinary  bronchial  catarrh 
has  a  tendency  to  extend  to  the  very  small  bronchial  tubes 
(capillary  bronchitis),  thence  into  the  air  cells  of  the  lungs. 
In  this  variety  of  pneumonia  the  lungs  do  not  become  in- 
flamed in  their  entirety,  but  here  and  there  patches  of  lung 


DISEASES   OF   CHILDREN.  353 

tissue  become  the  seat  of  lobular  pneumonia.  In  the  nurs- 
ling, catarrhal  pneumonia  is  an  extremely  frequent  affection 
and  I  believe  that  it  is  principally  due  to  the  carelessness 
and  promiscuous  bathing  of  infants  to  which  I  have  already 
referred.  In  foundling  hospitals  this  disease  destroys  a  great 
many  children,  and  the  chief  cause  has  been  attributed  to 
their  lying  both  night  and  day  in  a  horizontal  posture. 

It  has  been  statistically  proven  that  many  more  children 
suffer  from  the  disease  in  winter  than  in  summer,  and 
further,  that  in  those  parts  of  the  lung  that  are  inflamed  the 
bronchial  tubes  which  lead  to  them  are  also  found  to  be  in- 
flamed. This  relation  of  catarrhal  pneumonia  to  bronchitis 
may  be  accounted  for  by  the  play  of  a  mechanical  force  and 
thus  illustrates  the  relation  of  cause  and  effect.  The  secretion 
of  bronchitis  not  being  expectorated,  gravitates  into  the 
region  in  which  the  inflamed  bronchial  tubes  terminate, 
namely,  the  air  cells  of  the  lungs,  and  by  irritating  and  block- 
ing or  filling  the  air  cells,  a  catarrhal  pneumonia  is  devel- 
oped. 

The  symptoms  of  pneumonia  in  children  under  two  years 
of  age  are  those  of  the  catarrhal  or  lobular  type;  after  they 
have  passed  through  their  first  dentition  they  become  subject 
to  lobar  pneumonia  which  differs  in  no  particular  from  the 
disease  which  occurs  in  grown  persons.  Practice  and  experi- 
ence make  the  discovery  of  catarrhal  pneumonia  possible  in 
little  children  as  soon  as  they  are  under  observation  for  a 
little  while.  The  most  prominent  sign  is  the  rapidity  of  the 
respiration,  which  rises  to  sixty  and  eighty  per  minute  in- 
stead of  forty-four,  the  average  normal  respiration  for  the 
first  year  of  infantile  life. 

The  disease  begins  with  a  cough  and  more  or  less  fever, 
and  as  it  is  always  preceded  with  bronchitis,  the  symptoms 
that  were  enumerated  when  speaking  of  the  latter  disease  are 
equally  applicable  to  this  one.  Later  on,  when  the  transi- 
tion of  bronchial  catarrh  into  pneumonia  takes  place,  all  the 
symptoms  become  at  once  aggravated.  The  breathing,  for 
23 


354  HOME   TREATMENT. 

instance,  becomes  labored  and  increases  and  the  nostrils 
dilate  with  each  inspiration.  The  mouth  is  open,  and  its 
corners  are  drawn  downward  and  outward,  depicting  dis- 
tress and  suffering,  while  the  eyes  roll  anxiously  about  or 
become  glassy  and  staring. 

The  treatment  of  pneumonia  in  its  early  stages  would  be 
the  treatment  of  bronchitis,  since  every  pneumonia  in  young 
children  is  preceded  by  a  bronchial  catarrh.  The  uniform 
temperature  is  of  the  first  importance.  The  same  remedy 
that  was  suggested  for  the  cough  in  bronchitis  is  also  here 
serviceable. 

A  systematic  course  of  nourishment  must  form  a  part  of 
every  successful  treatment  for  pneumonia;  and  as  an  old 
medical  friend  once  told  me  in  a  consultation  "if  the  child  is 
kept  alive  long  enough  with  nourishment  it  is  bound  to  get  welV 
In  critical  cases  it  is  surprising  the  large  amount  of  whisky 
a  little  infant  consumes  with  avidity;  its  eyes  begging  and 
watchingly  following  the  teaspoon  from  the  cup  to  its  mouth. 
I  attended  my  own  child  once  when  only  three  months  old  and 
although  there  seemed  no  hope,  for  its  tiny  finger  tips  were 
blue  and  its  lips  livid  from  deficient  aeration,  yet  it  eagerly 
took  its  teaspoonful  of  whisky  toddy  every  fifteen  minutes 
through  the  longest  part  of  the  night,  and  towards  morning 
it  took  a  change  for  the  better  and  its  life  was  saved.  I  also 
believe  that  these  babies  must  be  kept  in  a  constant  sweat; 
this  relieves  the  congestion  of  the  lungs.  The  nourishment 
must  be  given  at  regular  intervals  of  several  hours  just  as 
you  would  give  medicine,  for  indeed  it  is  a  medicine  at  this 
time. 

Another  valuable  agent  to  which  I  attribute  a  number  of 
recoveries  is  the  application  of  a  moist  girdle  suggested  by 
Professor  Alfred  Vogel,  of  the  University  of  Dorpat,  Russia. 
In  his  work  on  "Diseases  of  Children"  he  says:  "A  diaper,  or 
large  white  pocket  handkerchief  is  folded  up  iikea  cravat;  the 
bandage  thus  obtained  should  be  three  or  four  fingers  wide, 
and  the  whole  length  of  the  handkerchief.     This  is  now 


DISEASES   OF    CHILDREN.  355 

dipped  in  warm  water,  and  wrung  out  so  that  the  cloth  does 
not  drip,  and  then  applied  like  a  girdle  around  the  chest  of 
the  child.  A  second  cloth,  double  the  size  of  the  first,  is 
folded  up  in  the  same  manner  like  it,  but  which  must  be  six 
to  eight  fingers  broad,  and  then  applied  dry  and  warm  over 
the  first.  It  is  very  advisable  to  interpose  a  piece  of  gutta 
percha  or  oil  silk  between  the  dry  and  the  wet  girdle  by 
which  on  the  one  hand,  the  moistness  of  the  first  cloth  is 
preserved  longer,  while  on  the  other,  the  second  does  not 
become  wet.  If  the  water  with  which  the  fomentations  are 
made  is  not  too  cold,  the  child  will  tolerate  them  very  well 
and  in  a  short  time,  a  slight  retardation  in  frequency  and 
improvement  of  the  respiration  are  indicated  by  less  motion 
of  the  nostrils.  These  warm  compresses  should  be  continued 
for  from  four  to  six  days,  and  it  is  not  at  all  necessary,  dur- 
ing the  entire  time,  to  remove  the  bandage;  the  oil  silk  is 
raised  up  a  little,  and  a  few  teaspoonfuls  of  water  are  poured 
upon  the  girdle  or  it  is  moistened  with  a  sponge.  The  prin- 
cipal thing  is  not  to  allow  a  cooling  of  the  skin  by  evapora- 
tion to  take  place.  To  secure  this  object,  the  dry  cloth 
should  properly  overlap  the  moist  one  on  all  sides  and  as  it 
is  impossible  to  prevent  the  upper  cloth  from  becoming  wet, 
it  should  be  changed  several  times  during  the  day.  I  cer- 
tainly have  applied  this  girdle  many  hundreds  of  times,  and 
have  very  often  seen  rapid  improvement  ensue;  neverthe- 
less, it  cannot  be  denied  that  the  half  of  these  children  per- 
ish notwithstanding.  If  cold  compresses  are  applied  the 
children  cry  of  fright  in  consequence,  and  the  symptoms  be- 
come worse  until  the  cold  water  has  become  warm."  The 
application  of  blisters,  cupping  or  leeching  should  not  be 
tolerated. 


CHAPTER    XXX. 

DISEASES  PECULIAR  TO  CHILDREN— Continued. 

(a)  Indigestion  in  very  young  children  is  generally 
accompanied  with  diarrhoea,  because  that  portion  of  the 
child's  food  which  is  not  thrown  up  or  digested  passes  along 
the  intestinal  canal  and  acting  as  an  irritant  causes  diarrhoea. 
An  indigestion  of  only  a  short  period  of  duration  excites  a 
catarrhal  inflammation  of  the  mucous  membrane  of  the 
stomach,  and  this  may  be  so  slight  that  even  a  change  or 
correction  in  the  diet  may  be  all  that  is  required  to  relieve 
it.  Children  who  are  suffering  from  indigestion  have  stom- 
ach ache;  this  may  be  continuous  or  come  on  half  an  hour 
or  an  hour  after  nursing.  The  pain  is  due  to  the  irritation 
caused  by  the  nutriment  or  to  the  fermentation  of  the  food 
and  the  consequent  accumulation  of  gas  within  the  stomach. 
The  stomach  becomes  distended  and  sensitive  to  pressure. 
When  the  catarrh  is  severe  the  nutriment  that  the  child 
takes  into  the  stomach  is  immediately  rejected  or  it  may 
vomit  glairy  or  greenish  mucus  from  an  empty  stomach. 
At  first  the  nutrition  of  the  child  may  not  be  greatly  inter- 
fered with,  for  some  of  the  food  is  retained  and  digested  in 
the  small  intestines,  but  in  the  course  of  time  these  too  be- 
come irritated  and  then  diarrhoea  complicates  the  case  and 
the  child  falls  off  and  becomes  rapidly  emaciated.  Children 
who  are  nourished  from  their  mother's  breasts  rarely  suffer 
from  indigestion,  but  those  who  are  fed  on  artificial  foods 
become  victims  of  stomach  and  bowel  troubles.  And  for 
this  reason  it  is  natural  to  suppose  that  the  chief  reliance  for 
a  successful  treatment  is  to  regulate  and  study  the  diet  of  the 

(356) 


DISEASES   OF    CHILDREN.  357 

sufferer;  the  chapter  that  is  especially  devoted  to  this  sub- 
ject should  be  consulted  for  further  information. 

(6)  Diarrhoea  is  a  derangement  of  the  stools  in  which 
they  loose  their  semi-solid,  pap-like  consistence  and  become 
watery  liquid  alone,  or  watery  liquid  in  which  indigested 
particles  of  food  and  fecal  matter  remain  suspended.  The 
quantity  of  alvine  matter  that  is  evacuated  greatly  exceeds 
that  which  passes  in  the  normal  state.  The  stools  have  an 
alkaline  or  acrid  nature  which  irritates  and  often  inflames 
the  anus  and  the  surrounding  integument.  "The  normal 
form  of  the  infantile  feces  in  the  first  year  of  life  is  the 
pappy;  the  color  is  yellow  like  that  of  the  yolk  of  egg;  the 
smell  is  feebly  acid,  never  putrid,  and  only  in  children  who 
are  fed  upon  a  meat  diet  as  repulsively  pungent  as  in  the 
adult;  in  later  years  they  are  no  longer  distinguished  from 
the  adult." 

The  passages  of  diarrhoea  may  be  simply  softer,  but  yel- 
lowish and  increased  in  quantity,  or  they  may  be  bright 
yellow  and  so  watery  as  to  squeeze  out  from  the  anus  as 
from  a  syringe  and  soak  through  diapers  and  bedclothes, 
or  the  stools  may  be  green,  or  bilious,  and  slimy.  When 
children  teethe  they  often  have  a  diarrhoea  for  several  days; 
this  intestinal  derangement  has  no  connection  with  improper 
feeding,  yet  it  requires  to  be  watched  lest  it  become  serious 
and  uncontrollable.  There  is  still  another  kind  of  diarrhoea 
which  is  foamy  and  contains  large  quantities  of  mucus  and 
little  or  no  coloring  matter.  For  the  different  varieties  one 
and  the  same  remedy  will  answer,  and  that  which  I  here 
submit  has  never  disappointed  my  expectation: — 

Take:  Subnitrate  of  Bismuth 1  dram 

Powdered  Kino 16  grains 

Rubbed  thoroughly  with 

Glycerine 1  dram 

Paregoric 2  drams 

Chalk  Mixture,  sufficient  to  make 2  ounces 

Shake  the   mixture   thoroughly  before  using,  and   the 


35S  HOME    TREATMENT. 

dose  can  be  regulated  between  ten  drops  for  an  infant  to  a 
teaspoonful  for  a  child  three  or  four  years  old. 

(c)  Dysentery  or  Flux  is  an  inflammation  of  the  mu- 
cous membrane  of  the  large  intestine,  or  colon,  extending 
down  to  the  rectum.  Children  under  one  year  of  age  are 
not  as  liable  to'  this  affection  as  those  who  are  older,  and  it 
is  during  their  first  dentition  that  the  affection  shows  itself. 
In  hot  summer  months,  at  the  season  of  unripe  fruits,  the 
disease  often  becomes  epidemic.  The  loss  of  strength  and 
flesh  is  very  rapid,  and  when  children  do  not  perish  during 
the  first  few  days  of  their  sickness,  they  may  succumb  later 
when  the  disease  has  assumed  a  chronic  form.  Dysentery 
is  extremely  liable  to  become  complicated  with  pneumonia, 
anaemia,  pyaemia,  perforations  and  strictures  of  the  intes- 
tines, jaundice  and  abscess  of  the  liver,  and  in  proportion 
that  these  complications  become  developed  life  becomes  seri- 
ously threatened.  The  symptoms  of  dysentery  are  striking 
and  can  hardly  be  mistaken  for  anything  else.  There  is 
always  pain  over  the  abdomen,  but  on  touching  the  abdomen 
near  the  navel  and  over  the  course  of  the  colon  the  pain  is 
greater  than  elsewhere. 

Tenesmus  is  a  characteristic  symptom  of  dysentery. 
This  is  a  straining  sensation  as  if  the  bowels  wanted  to 
move,  yet  notwithstanding  the  violent  bearing  down,  only 
a  little  mucus  often  streaked  with  pus  or  blood  is  discharged. 
The  straining  causes  the  lower  folds  of  the  rectum  to  protrude, 
and  this  portion  of  the  bowel  presents  a  livid  red  color;  the 
sufferer  is  tormented  a  great  deal  by  this  fruitless  bearing 
down,  and  the  bowels  should  be  anointed  with  pure  zinc 
ointment  and  returned.  The  stools  of  the  child  are  charac- 
teristic of  this  disease.  Every  passage  contains  glairy  mu- 
cus formed  into  lumps  resembling  granules  of  boiled  starch, 
streaked  with  blood  and  associated  with  a  creamy  looking 
substance  which  is  purulent  matter.  If  the  disease  has 
progressed  to  the  formation  of  ulcers  the  evacuations  be- 
come grayish  red  or  assume  a  dirty  ashen  color,  and  the 


DISEASES   OF   CHILDREN.  359 

odor  is  putrescent.  Portions  of  the  mucous  membrane 
slough  off  and  large  quantities  of  pus  are  discharged  from 
the  ulcerating  surfaces  so  that  the  stools  present  sometimes 
nothing  but  purulent  and  bloody  matter. 

The  treatment  for  this  disease  must  be  prompt  and  di- 
rected to  the  point;  reliance  must  not  be  placed  upon  one 
single  remedy,  but  a  combination  of  expedients  must  be  re- 
sorted to. 

The  greatest  annoyance  and  source  of  pain  is  the  strain- 
ing and  tenesmus,  and  to  relieve  this  steps  must  at  once  be 
taken.  There  is  hardly  any  use  to  give  injections  for  this 
purpose  for  the  irritable  condition  of  the  rectum  makes  it 
impossible  for  the  child  to  retain  them  long  enough  to  do 
any  good.  Use  suppositories  instead,  and  if  need  be,  retain 
them  by  holding  a  soft  compress  of  cloth  over  the  anus,  for 
ten  to  fifteen  minutes  until  they  are  dissolved.  For  example, 
to  a  child  one  year  old  I  employ  the  following  suppository : — 

Take:  Laudanum 1  drop 

Cocaine -^  grain 

Bismuth  Subnitrate .10  grains 

Cocoa  Butter 10  grains 

Make  into  one  long  suppository  and  roll  in  powdered  bis- 
muth, dip  it  first  into  oil  or  vaseline  and  insert  into  the  rec- 
tum every  three  or  four  hours  until  the  soreness  and  straining 
have  subsided.  If  the  child  is  not  very  sensitive  nor  very 
ill  an  injection  of  a  teaspoonful  of  boiled  liquid  starch  to 
which  a  few  drops  of  laudanum  have  been  added,  may  be 
used  instead  and  as  often  as  may  be  necessary.  Cold  drinks 
aggravate  the  pains,  therefore  give  everything  warm. 

Cow's  milk  should  be  dispensed  with  in  artificially  fed 
children,  and  broths  substituted  to  which  a  portion  of  a  fresh 
egg  isadded,  previously  thoroughly  beaten  with  an  egg  beater; 
in  very  young  children  the  yolk  alone  should  be  used.  A  little 
whisky  is  always  good  for  this  class  of  patients,  either  in 
their  broth,  or  given  as  a  toddy  in  teaspoonful  doses  for  the 
children  are  generally  always  thirsty  and  feverish.     When 


360  HOME   TREATMENT. 

children  lose  their  appetites  and  refuse  nourishment  they 
must  be  coaxed  and  even  forced  to  take  food  at  regular 
intervals,  otherwise  they  cannot  rally  and  will  perish  from 
inanition.  The  medicine  that  I  recommended  for  diarrhoea 
is  also  very  useful  for  dysentery. 

(d)  Colic  is  the  result  of  an  abnormal  accumulation  of 
gas,  flatulency,  in  the  small  intestine.  There  is  always  more 
or  less  gas  in  both  stomach  and  bowels,  but  usually  this 
passes  off  and  there  is  no  pain  felt  from  it.  It  is  when  the 
quantity  increases  so  as  to  distend  the  bowels  that  the  walls 
of  the  intestines  become  the  seat  of  pain.  The  pain  comes 
on  in  paroxysms,  or  fits  at  short  intervals,  and  increasing  in 
violence.  Children  suffering  from  colic  have  the  abdomen 
swollen  or  bloated,  giving  rise  to  that  condition  termed 
meteorismus  or  tympanites.  Those  who  are  under  one  year 
old  are  the  most  liable  to  colicky  pains,  for  it  is  during  this 
period  of  life  that  digestive  disturbances  are  the  most 
frequent,  and  these  constitute  the  chief  cause.  Whenever 
the  vermicular  motion  of  the  intestines  becomes  lessened  or 
suspended,  the  gas  is  not  expelled  from  the  anus,  and  the 
accumulation  causes  the  characteristic  pains  under  consid- 
eration. In  perfectly  healthy  digestion  there  is  always  more 
or  less  gas  developed,  and  even  then  there  may  be  colicky 
pains.  The  same  pains  originate  with  every  diarrhoea  that 
is  due  to  improper  food  or  feeding,  and  in  dysentery  too  they 
are  generally  present.  Infants  who  nurse  at  their  mother's 
breasts  are  less  liable,  but  not  altogether  exempt,  for  moth- 
ers' milk  is  very  sensitive  to  impressions  of  purely  physical 
exertions,  or  to  emotions  of  fear  or  fright,  thus  her  milk  may 
become  unhealthy  for  her  child;  or  through  her  own  diges- 
tion, suffering  from  temporary  or  permanent  derangement, 
her  milk  may  transmit  a  similar  condition  to  her  child;  the 
mother  may  have  eaten  green  fruit,  or  too  much  of  a  variety, 
or  it  may  be  too  highly  seasoned,  or  too  fatty.  Many  moth- 
ers and  nurses  look  upon  the  colic  cry  as  a  hunger  cry,  and 
hasten  to  feed  the  little  one,  and  sometimes  a  few  teaspoon- 


DISEASES   OF   CHILDREN.  361 

fills  of  milk  or  broth  will  relieve  the  cry  for  a  few  minutes, 
then  the  pain  returns  severer  than  ever,  and  the  baby  cries 
louder  than  ever.  I  have  seen  very  nervous  children  thrown 
into  convulsions  from  severe  colicky  pains. 

My  rule  has  been  for  years  to  nurse  infants  for  the  first 
two  months  not  oftener  than  once  in  two  hours;  after  that 
until  they  are  six  months  old,  every  three  hours,  and  from 
six  to  twelve  months  every  four  hours;  between  times  the 
babies  cry,  of  course,  not  because  they  are  hungry,  but 
because  they  have  either  pain  or  are  thirsty.  The  old  Ger- 
man household  remedy  for  this  is  fennel  seed  tea;  there  is  noth- 
ing as  useful;  it  expels  the  gas  and  it  quenches  the  thirst 
from  which  colicky  children  suffer,  at  least  while  they  have 
the  colic.  This  tea  should  be  given  regularly  between 
times,  and  until  they  are  twelve  or  fifteen  months  old  ;  it  is 
soothing,  and  what  is  of  equal  importance,  it  prevents  over- 
feeding, wdiich  is  the  bane  of  artificially-fed  children.  The 
latter,  bottle-fed  babies,  are  all  more  or  less  colicky,  and  for 
these  the  fennel  seed  tea,  between  bottle  time  is  indeed  a  balm. 
If  the  fennel  seed  tea  does  not  relieve  the  child  at  once,  or  if 
the  pain  seems  severe,  then  add  a  few  drops  of  paregoric  to 
the  fennel  seed  tea,  and  give  an  injection  of  German  chamo- 
mile tea,  rubbing  the  bowels  at  the  same  time  with  a  mixture 
of  turpentine  and  sweet  oil,  and  I  believe  that  every  case 
will  be  relieved.  Permanent  relief  must  be  sought  in  ferret- 
ing out  the  cause  and  removing  it.  This  may  be  due  to 
improper  food,  or  feeding,  to  indigestible  contents  in  the 
stomach  or  bowels,  and  indeed,  very  often  to  constipation. 
When  the  stomach  is  overloaded,  a  dose  of  syrup  of  ipecac 
may  give  relief,  and  if  due  to  constipation,  the  Femina 
laxative  syrup  is  the  most  appropriate  remedy. 

(e)  Convulsions,  or  spasms  in  children  have  long  been 
well  known  to  the  laity,  and  from  their  frequent  occurrence 
they  make  an  important  class  of  children's  diseases.  If 
there  is  one  thing  more  frightful  to  behold  than  another,  to 
the  young  and  inexperienced  mother,  it  is  to  see  her  baby's 


362  HOME    TREATMENT. 

eyes  unsteadily  rolling,  or  turned  up  so  as  to  show  only  the 
white  of  the  eyeballs,  or  may  be  the  e}res  steadily  fixed  in 
a  stare  while  the  child  becomes  completely  unconscious.  A 
painful  smile  may  play  over  its  face,  or  an  expression  of 
fear  or  anger  may  distort  the  facial  expression,  while  the 
muscles  of  the  face  twitch  convulsively.  The  jaws  are 
sometimes  set,  then  again  there  is  gnashing  of  the  teeth, 
alternating  with  relaxation  of  muscles  and  ligaments.  The 
child  cannot  swallow,  and  fluids  poured  into  the  mouth  flow 
out  again.  The  other  muscles  of  the  body  also  participate  in 
the  spasmodic  contractions;  those  of  the  back  contract  and 
relax,  and  those  of  the  extremities  are  involved  in  lively 
twitchings,  or  perform  acts  of  thrashing,  striking  or  twist- 
ing. The  breathing  becomes  very  irregular,  and  from  the 
spasms  of  the  muscles  of  the  larynx  or  throat  it  may 
become  entirely  suspended,  and  if  the  spasm  does  not  sub- 
side in  two  or  three  minutes  the  child  may  die.  The  skin 
becomes  livid  or  congested  and  loses  its  sensibility  so  that 
blisters  or  irritants  make  no  painful  impression.  Some- 
times the  child  bleeds  from  the  nose  or  mouth ;  the  latter  is 
generally  due  to  the  tongue  having  been  caught  between 
the  teeth  during  the  paroxysm.  Frothy  saliva  wells  up 
from  the  mouth  and  the  urine  and  stools  are  involuntarily 
discharged. 

All  convulsive  attacks  have  not  every  symptom  above 
enumerated,  some  of  them  are  usually  absent  and  an  attack 
may  be  quite  mild,  and  last  only  a  few  moments;  if  convul- 
sions last  longer  they  are  not  only  dangerous,  but  indicate 
serious  disease,  either  of  the  brain  or  in  which  the  brain  or 
spinal  cord  is  seriously  complicated. 

The  period  of  the  child's  life  at  which  convulsions  are 
most  frequent  is  from  the  time  they  are  born  up  to  the  com- 
pletion of  the  first  dentition.  Nervous  children  who  had 
convulsions  while  they  were  teething  are  susceptible  to  vio- 
lent attacks  at  the  commencement  of  various  diseases  or 
during  the  developmental  stage  of  the  eruptive  fevers.     Per- 


DISEASES   OF    CHILDREN.  363 

haps  the  most  frequent  cause  of  convulsions  in  children  is 
the  eruption  of  teeth.  The  irritation  which  a  growing  tooth 
causes  in  the  gums  also  irritates  its  nerve  and  this  irritability 
is  reflected  on  the  brain,  and  this  causes  the  spasm.  An 
overloaded  stomach,  worms  and  digestive  disturbances  that 
accompany  teething  irritate  the  bowels  and  from  this  too 
convulsions  ensue.  The  treatment  for  convulsions  naturally 
resolves  itself  into  first  giving  instant  relief  during  the  par- 
oxysm, and  secondly,  finding  out  the  cause  of  the  attack. 
The  latter  is  not  always  easy  at  first  sight,  and  as  the  cause 
may  be  serious  a  competent  physician  should  be  sent  for. 
But  instructions  that  are  serviceable  while  the  convulsion  is 
on  are  of  the  greatest  importance  to  mother  and  child.  The 
old  and  familiar  remedy  of  giving  the  child  a  hot  bath  as 
soon  as  possible  is  certainly  the  best  thing  that  can  be  done. 
The  child  should  be  undressed  as  quickly  as  possible  so  as 
to  relieve  it  from  all  constriction  and  so  that  nothing  can  in- 
terfere with  the  respiration  and  circulation. 

A  towel  wrung  out  of  cold  water  should  be  placed  over 
the  child's  head  and  its  body  immersed  in  hot  water  that  is 
not  so  hot  as  to  scald;  the  hands  on  which  the  child  is  sup- 
ported while  in  the  water  must  be  well  able  to  stand  the 
heat.  When  the  spasm  has  subsided,  the  child  should  be 
transferred  to  a  previously  warmed  woolen  blanket  in  which 
it  is  to  be  wrapped  with  its  head  softly  elevated.  If  the 
bowels  are  constipated  an  enema  of  warm  water  and  a  little 
castile  soap  should  be  administered. 

(f)  Worms  of  different  species  infest  the  human  organ- 
ism; they  get  into  the  system  from  the  outside  world,  with 
the  food  we  eat  and  drink.  Their  abiding  place  seems  to  be 
the  mucous  membrane  of  the  intestinal  canal  with  the  ex- 
ception of  the  trichinae  which  penetrate  the  mucous  mem- 
brane and  make  their  way  to  the  different  muscles  throughout 
the  body;  the  voluntary  muscles  seem  to  be  their  permanent 
dwelling  place.  These  parasites  are  peculiar  to  the  meat  of 
the  hog  and  as  very  young  children  do  not  eat  this  meat, 
they  are  so  far  totally  exempt  from  them. 


364  HOME    TREATMENT. 

Tapeworms  are  rarely  found  in  children  under  one 
year  of  age;  it  is  when  they  get  older  and  especially  when 
they  eat  hog's  meat,  for  this  too  is  the  home  of  the  embryo 
tapeworm,  that  they  become  infected. 

The  roundworm,  however,  is  peculiar  to  childhood.  It 
is  a  yellowish  or  whitish  worm  resembling  the  earthworm, 
from  one  to  twelve  inches  in  length.  The  body  is  round, 
tapering  toward  each  extremity.  This  worm  inhabits  the 
small  intestine,  but  by  acts  of  vomiting  they  are  frequently 
ejected  from  the  mouth  or  they  ma}''  find  their  way  into 
other  cavities.  On  the  Pacific  slope  these  worms  are  not  as 
frequently  met  with  as  on  the  other  side  of  the  Rockies.  It 
is  propagated  by  ova  and  taken  into  the  system  by  means  of 
drinking  water  containing  them.  The  number  varies  greatly 
in  different  cases;  sometimes  there  are  only  a  few  and  again 
there  may  be  dozens  or  hundreds  coiled  together  so  as  to 
form  balls  or  masses.  They  are  most  common  between  the 
ages  of  three  and  ten  years.  I  do  not  believe  that  they  ever 
exist  in  early  infancy. 

The  symptoms  denoting  the  presence  of  these  parasites 
are  on  the  whole  obscure  and  depend  somewhat  on  the  tem- 
perament of  the  individual.  A  nervous  child  may  be  thrown 
into  fits  or  convulsions  from  them.  My  first  case  of  these 
worms  in  a  child  seven  years  old  was  rather  exceptional  and 
remarkable.  The  child  was  suddenly  taken  with  a  severe 
attack  of  spasmodic  croup,  for  which  I  prescribed  remedies 
without  much  relief.  After  the  second  day  the  child  passed 
five  large  roundworms,  the  croup  subsided,  and  while  I 
claimed  no  credit  that  my  remedies  did  not  cure  the  croup 
it  was  generally  conceded  that  they  killed  the  worms. 

The  usual  symptoms  are  colic  pains,  impaired  appetite, 
diarrhoea,  itching  of  the  nose,  swollen  abdomen,  puffy  fea- 
tures, offensive  odor  of  breath,  dreaming  sleep  and  grinding 
the  teeth  during  sleep  or  twitching  of  the  muscles. 

The  expulsion  of  the  parasite  is  generally  effected  with 
simple  remedies.     Five  to  ten  drops  of  spirits  of  turpentine 


DISEASES    OF    CHILDREN.  365 

in  half  to  one  tablespoonful  of  castor  oil  is  a  reliable  remedy. 
The  oil  of  wormseed  is  another  convenient  remedy  in  the 
same  dose  on  a  lump  of  sugar  or  mixed  with  oil;  a  cupful  of 
tansy  tea  early  three  or  four  mornings  on  an  empty  stomach 
serves  a  useful  purpose;  pinkroot  and  senna  administered  as 
a  tea  has  also  a  well-deserved  popularity. 

The  thread,  pin,  spring  or  mawworm  inhabits  the  large 
intestine  and  chiefly  the  rectum.  It  is  a  thin  yellowish- 
white  parasite  from  one-twelfth  to  one-third  inch  in  length; 
the  female  has  a  straight,  awl-like,  pointed  tail,  the  male  has 
a  strongly  curved  tail.  It  rarely,  if  ever,  enters  the  small 
intestines.  The  worms  occur  chiefly  in  voung  children,  but 
there  is  no  period  of  life  that  is  exempt  from  them.  They 
cause  pain  and  an  itching  sensation  at  the  anus.  This  is 
particularly  troublesome  when  the  children  lie  in  warm  beds. 
The  sexual  organs  are  apt  to  become  excited  from  the  irrita- 
tion and  the  habit  of  masturbation  be  thus  formed.  In  girls 
the  worms  may  travel  into  the  vagina  and  leucorrhcea  in 
children  is  often  accounted  for  in  this  way;  around  the  anus 
there  may  be  pimply  redness. 

From  the  loss  of  appetite  and  sleep  the  general  health  of 
the  child  may  become  impaired;  but  the  only  possible  evi- 
dence of  the  presence  of  worms  is  to  examine  the  stools.  If 
worms  of  the  above  description  cannot  be  seen,  yet  the  symp- 
toms make  their  existence  suspected,  a  dose  of  some  of  the 
remedies  above  suggested  should  be  given  and  afterwards 
the  stools  again  examined.  Some  children  have  a  peculiar 
predisposition  to  pinworms,  and  although  you  seem  to  give 
them  relief  for  the  time  being,  in  a  short  time  afterwards  the 
same  s}rmptoms  return  and  the  worms  are  as  numerous  as 
ever.  In  these  cases  a  course  of  continual  treatment  becomes 
necessary  to  eradicate  the  morbid  habit;  for  this  course  I 
recommend: 

Take:  Powdered  wormseed, 
Powdered  chocolate, 
Milk  of  sulphur,  of  each  equal  parts. 


366  HOME    TREATMENT. 

Mix  and  give  half  to  one  teaspoonful  every  night  at  bed- 
time. 

(g)  Constipation  is  the  bane  of  artificially  reared  children 
and  if  the  sagacity  of  mother  or  nurse  does  not  correct  the 
evil  it  often  causes  serious  complications.  Sometimes  those 
who  are  nursed  on  the  breast  suffer  from  constipation,  espe- 
cially when  the  mothers  or  wet  nurses  are  troubled  with  sim- 
ilar derangements  Children  under  one  year  of  age  should 
have  two  evacuations,  and  those  from  one  to  three  years 
should  have  at  least  one  passage  a  day;  when  this  does  not 
occur  the  feces  become  solid  and  constipation  is  the  result. 
In  most  febrile  affections  constipation  is  caused  by  a  loss  of 
moisture  through  the  skin  and  an  increased  urinary  secre- 
tion. Certain  foods  constipate,  especially  the  starchy  or 
farinaceous  variety,  as  soups  containing  corn  starch,  rice, 
sago,  etc.,  and  in  older  children  certain  dishes  consisting  of 
peas,  beans,  and  wheaten  bread.  A  great  many  medicines 
are  constipating,  for  instance,  most  cough  mixtures,  for  they 
contain  opium  in  some  form,  also  preparations  of  iron,  lead, 
alum,  bismuth,  chalk,  and  vegetable  remedies  that  contain 
astringents  or  tannin. 

It  must  be  laid  down  as  a  rule  never  to  be  violated, 
that  every  child  must  have  at  least  one  passage  a  day  from 
the  day  it  is  born,  and  it  is  the  imperative  duty  of  mother 
or  nurse  to  see  that  it  is  accomplished.  The  infant  of  only 
a  few  days  or  weeks  old  may  require  only  a  few  drops  of 
olive  oil,  but  if  that  delays  in  its  effect  it  may  become  neces- 
sary to  give  relief  at  once,  and  for  this  purpose  we  have  in 
a  small  warm  water  enema  a  most  decided  and  effectual 
remedy.  Soapsuds  should  never  be  used,  except  in  very 
urgent  cases,  for  I  have  known  a  diarrhoea  to  ensue  from  the 
irritation  it  caused  which  was  very  hard  to  control.  If  the 
feces  are  not  very  hard  a  soap  suppository  may  be  used  with 
good  advantage,  and  in  the  following  manner:  Take  a  piece 
of  soap  and  pare  it  to  a  point  the  thickness  of  a  lead 
pencil  and  about  an  inch  long,  moisten  this  and  introduce 


DISEASES   OF    CHILDREN.  367 

carefully  into  the  rectum;  if  the  straining  bring  only  the 
soap  away  it  may  be  well  to  use  the  water  enema  afterward. 
If  the  constipation  continues  to  be  habitual  a  slight  modifi- 
cation of  the  diet  becomes  necessary;  starchy  foods  must 
not  be  given  as  often,  and  thinner  than  formerly;  the  milk 
too  should  be  more  diluted;  broth  or  beef  tea  substituted 
once  or  twice  each  day  will  often  have  a  good  effect.  When 
children  are  old  enough  to  eat  mixed  food  the  diet  can  often 
be  so  regulated  as  to  materially  contribute  towards  opening 
the  bowels.  The  children  should  be  encouraged  to  drink  a 
great  deal  of  water;  from  the  lack  of  that  alone  some  chil- 
dren become  constipated.  Graham  bread  and  boiled  Ger- 
man prunes  are  especially  to  be  recommended;  so  are  ripe 
raw  fruits,  grapes,  strawberries,  apples,  pears,  etc.  Children 
require  fresh  air  and  outdoor  exercise  to  be  well  and  robust; 
they  run  and  jump  more  when  in  the  open  air,  all  of  which 
gives  tone  and  strength  to  the  general  system.  If  diet  and 
outdoor  exercise  alone  does  not  remedy  the  evil,  then  the 
Femina  laxative  syrup  should  be  administered;  it  is  effi- 
cient in  its  action,  and  pleasant  to  take,  and  unlike  most 
laxative  or  aperient  remedies,  there  is  no  danger  of  forming 
a  habit  of  using  purgatives. 

(h)  Whooping  cough  is  the  name  of  an  affection  deriv- 
ing its  significance  from  a  characteristic  which  is  peculiar 
to  this  cough.  It  commences  like  an  ordinary  bronchitis 
such  as  is  the  result  of  taking  cold ;  there  is  the  usual  hoarse- 
ness, tickling  in  the  throat,  dry  cough,  sneezing,  running  from 
the  nose;  the  eyes  are  red  and  watery,  and  there  is  more  or  less 
fever.  Sometimes  the  cough  is  ordinary,  but  at  other  times 
it  has  a  sharp  metallic  clang  from  the  beginning.  Owing 
to  certain  marked  periods  in  the  course  of  the  affection  it 
has  been  found  convenient  to  divide  it  into  three  stages 
which  may  usually  be  distinguished,  although  in  a  certain 
proportion  of  cases  the  first  stage  (comprising  some  of 
the  symptoms  that  have  been  enumerated  above)  may  be 
submerged   into  the  second  or  whooping  stage.     The  first 


368  HOME   TREATMENT. 

stage  may  last  from  four  to  five  days  to  as  many  weeks. 
The  second  stage  is  when  the  peculiar  sound  or  whoop 
begins;  it  consists  of  a  great  number  of  violent  paroxysms, 
rapidly-recurring  spasmodic  coughs,  until  most  of  the  air  in 
the  lungs  is  expired;  there  is  then  a  sense  of  suffocation  and 
the  child  becomes  bluish  red  over  the  entire  head  and  face, 
from  which  the  German  designation  blue  cough  has  originated. 
During  this  spell  the  face  swells  and  the  eyeballs  become 
congested  and  bulge  from  their  orbits  and  the  nose  often  be- 
gins to  bleed,  while  the  urine  and  feces  are  often  involun- 
tarily ejected  and  the  contents  of  the  stomach  thrown  up 
from  the  violent  contraction  of  the  diaphragm.  In  a  few 
moments  the  spell  is  broken  by  a  protracted,  whistling 
croupy  inspiration,  and  this  constitutes  the  whoop. 

The  whooping  generally  grows  worse  the  first  two  or 
three  weeks,  after  which  time  in  favorable  cases  the  cough 
gradually  becomes  milder,  but  this  is  not  the  rule  by  any 
means.  I  have  had  it  in  my  own  family  to  last,  in  two  in- 
stances, six  months,  and  in  another  eight  months  before  the 
children  had  fully  recovered. 

Laughing  or  crying,  swallowing  dry,  irritating  morsels 
of  food  or  cold  and  impure  air  will  bring  on  a  paroxysm  of 
cough.  When  several  children  are  affected  together,  the 
coughing  of  one  will  make  the  others  cough. 

The  third  stage  is  when  the  cough  is  wearing  off  and  has 
lost  its  severity.  The  expectoration  consists  now  of  a  yel- 
lowish or  green-colored  mucus;  in  otherwise  healthy  chil- 
dren this  lasts  only  a  few  weeks,  but  in  weakly  or  scrofulous 
ones  it  may  last  for  several  months.  This  disease  is  not  as  yet 
thoroughly  understood.  It  is  an  epidemic,  contagious  bron- 
chial catarrh,  involving  the  nerves  of  respiration  and  at- 
tacks an  individual  but  once.  When  complications  arise  the 
affection  becomes  exceedingly  dangerous  and  the  most  com- 
mon of  these  is  pneumonia. 

There  is  no  specific  cure  for  whooping  cough;  it  has  got 
to  run  its  course,  which  may  be  either  short  or  long.     I  have 


DISEASES   OF    CHILDREN.  369 

tried  every  agent  so  far  known  to  scientific  medicine, and  there 
is  none  that  will  give  prompt  relief  in  every  instance.  Whoop- 
ing cough  being  a  bronchitis  plus  something  else,  it  seems 
rational  that  the  same  precautions  that  are  observed  in  a  case 
of  bronchitis  should  be  followed  here.  Children  with  this 
affection  must  not  be  exposed  to  drafts  or  rough  winds  lest 
they  get  cold,  which  might  seriously  complicate  matters.  In 
summer  when  the  weather  is  warm,  out-door  life  is  beneficial 
in  hastening  recovery.  Some  children  have  the  cough  so 
light,  that  no  extra  precautions  seem  to  be  necessary;  they 
have  no  fever,  eat,  feel  and  sleep  well.  But  those  who  are 
feverish,  who  vomit  freely,  and  whose  appetite  is  capricious, 
require  every  attention.  Their  diet  should  be  especially 
guarded,  so  that  all  dry,  irritating  nutriments  are  prohibited, 
and  so  that  the  diet  consists  principally  of  liquid  nourishment. 
Warm  drinks  have  a  favorable  influence  on  the  disease ;  a 
plentiful  supply  of  warm  milk,  first  thoroughly  beaten  with 
an  egg  beater  is  the  most  suitable  and  convenient.  The  milk 
punch  is  often  borne  well,  and  the  little  whisky  that  enters 
into  its  composition  is  a  needed  stimulant  to  the  sufferer; 
broths  may  be  given  for  a  change,  and  to  these  the  yolk  of 
an  egg  can  be  added  with  advantage.  A  great  many  reme- 
dies might  be  suggested,  but  the  one  which  has  served  my 
purpose  the  best,  is  the  following: 

Take:  Deodorized  tincture,  of  opium £  dram 

Fluid  extract,  of  belladonna 4  drops 

Fluid  extract,  of  ipecac 10  drops 

Simple  syrup 2  ounces 

For  a  child  five  years  old,  give  a  teaspoonful  three  or 
four  times  a  day;  older  or  younger  children  in  proportion. 
If  the  cough  is  hard  and  dry,  ten  to  twenty  drops  of  syrup 
of  ipecac  alone  should  be  given  instead  of  the  mixture,  and 
when  the  cough  is  loosened,  the  mixture  can  be  again  admin- 
istered. When  in  the  course  of  the  affection  the  breathing 
suddenly  becomes  labored,  and  the  fever  increases,  it  is  fair 
to  presume  that  the  case  is  complicated  with  pneumonia. 
24 


370  HOME   TREATMENT. 

(i)  Eruptive  fevers,  as  their  name  implies,  are  char- 
acterized by  an  eruption  or  exanthema.  The  most  virulent 
of  this  class  is  smallpox.  The  eruption  of  this  disease  is  of 
the  nature  of  vesicles,  or  pustules,  while  that  of  measles, 
scarlatina,  and  rose  rash  is  dry,  and  is  properly  called  a  rash. 
Chickenpox,  however,  has  also  vesicles  and  pustules,  and 
for  this  reason  it  is  very  liable  in  times  of  an  epidemic  of 
smallpox  to  be  mistaken  for  a  mild  form  of  the  latter  dis- 
ease. For  obvious  reasons  it  is  not  proper  to  consider  small- 
pox in  this  connection;  its  gravity  and  its  management 
require  experience,  and  further,  it  generally  comes  under 
special  quarantine  regulations  of  the  proper  constituted 
authorities. 

The  eruptive  fevers  are  all  divided  into  three  stages, 
namely:  a  stage  of  invasion  or  development;  a  second 
stage  when  the  eruption  appears,  and  while  it  lasts;  and 
a  third  stage,  that  of  desquamation,  when  the  eruption  begins 
to  fade  or  exfoliate  in  branny  scales. 

(j )  Measles  is  generally  a  mild  and  not  serious  disease, 
and  only  attacks  the  individual  but  once  in  a  lifetime ;  only 
through  gross  carelessness  the  disease  becomes  complicated, 
and  then  it  may  become  a  very  dangerous  affection.  It 
begins  with  all  the  symptoms  of  a  common  cold.  There  is 
frequent  sneezing,  and  an  acrid  muco-serous  discharge  from 
the  nostrils.  The  eyes  are  irritable,  reddened  and  watery, 
and  there  is  more  or  less  intolerance  of  light.  The  voice 
becomes  hoarse  and  there  is  always  a  bronchitis  present 
which  is  characterized  by  a  dry,  harsh  cough.  The  patient 
is  generally  feverish,  alternating  with  chilly  sensations  or 
shivering;  the  appetite  is  poor  or  absent  and  in  some  cases 
there  is  nausea  and  vomiting.  The  children  feel  drowsy; 
they  complain  of  pain  in  the  head  and  limbs  and  want  to 
lounge  around.  The  bowels  may  be  constipated,  but  diar- 
rhoea supervenes  in  a  certain  proportion  of  cases.  In  nervous 
children  convulsions  may  occur;  bleeding  from  the  nose 
and  false  croup  are  not  infrequently  met  with  in  the  develop- 


DISEASES   OF    CHILDREN.  371 

ment  of  this  disease.  The  duration  of  the  first  stage  varies 
greatly  in  different  individuals,  and  comprises  a  period 
•extending  from  one  to  seven  days.  The  eruption  begins 
generally  on  the  temples  and  forehead,  whence  it  extends 
over  the  head  and  neck,  thence  down  the  back  and  over  the 
-entire  body,  occupying  in  its  development  from  thirty-six  to 
forty-eight  hours.  The  eruption  bears  a  resemblance  to  flea 
bites  at  first;  it  appears  as  minute  red  specks  which  gradually 
•enlarge  and  become  slightly  elevated  and  arrange  them- 
selves in  circular  clusters.  The  portions  of  the  skin  that 
are  free  from  the  eruption  retain  their  white  appearance;  the 
face  is  more  or  less  swollen  and  the  eyelids  puffed.  In  some 
patients  there  is  considerable  annoyance  from  itching  in  the 
skin.  The  cough  and  bronchitis  continue  to  be  prominent 
symptoms,  and  the  expectoration,  consisting  of  yellowish 
sputa  becomes  abundant.  In  some  children  the  fever  runs 
very  high  in  this  stage  and  they  become  delirious  and  rest- 
less, but  this  is  only  temporary,  for  it  generally  diminishes 
with  the  eruption  on  the  third  or  fourth  day. 

When  the  eruption  begins  to  fade  the  third  stage  of  the 
affection  is  inaugurated,  and  when  there  exist  no  complica- 
tions, the  patient  may  now  be  considered  on  the  way  to 
recovery  which  takes  from  four  to  eight  days  longer. 

The  treatment  in  measles  should  consist  in  good  nursing, 
rather  than  in  medication.  Owing  to  the  inflammation  of 
the  membranes  of  the  eyes,  the  patient  should  be  kept  in  a 
•darkened  chamber,  and  the  eyes  occasionally  bathed  with  a 
solution  of  borax,  by  dissolving  half  a  teaspoonful  in  a  tum- 
blerful of  water.  Good  judgment  forbids  that  the  patient 
should  be  sweltered,  but  that  he  should  be  kept  comfortably 
warm  and  never  allowed  to  cool  off  suddenly  is  also  very 
important.  When  the  eruption  is  slow  to  develop  a  good 
sweat  will  often  bring  it  out;  so  will  undue  exposure,  to  cold 
drafts  and  the  transportation  out  of  a  warm  bed  into  a  cold 
one  or  drinking  immoderately  of  cold  drinks  either  delay 
the  development  of  the  eruption  or  drive  it  back,  and  from 


372  HOME    TREATMENT. 

this  undoubtedly  dangerous  complications  arise,  like  pneu- 
monia, diphtheritic  croup,  and  convulsions.  A  mouthful 
of  cold  water  now  and  then  is  harmless,  but  on  the  whole 
the  drinks  should  be  quite  warm;  the  cough  and  bronchitis 
alone  would  require  that. 

Warm  milk  thoroughly  beaten  is  the  most  suitable  form 
of  diet;  broths  and  soups  may  be  given  for  a  change,  so  can 
a  mixture  of  equal  parts  of  weak  hot  tea  and  milk.  The 
bowels  should  be  moved  with  a  mild  laxative  and  if  the 
fever  runs  very  high,  ten  to  fifteen  drops  of  the  sweet  spirits 
of  nitre,  for  a  child  five  years  old,  in  half  wineglass  of  water 
every  few  hours  will  generally  reduce  the  temperature.  For 
the  itching,  the  skin  should  be  rubbed  with  equal  parts  of 
glycerine  and  warm  water.  The  cough  is  generally  the 
most  troublesome  feature,  and  the  only  symptom  requiring 
regular  medication;  for  this  a  good  general  cough  mixture- 
will  serve  every  purpose,  such  as: 

Take :  Compound  mixture  of  liquorice, 

Syrup  of  wild  cherry,  of  each 2  ounces- 
Mix  and  give  to  a  child  four  years  old  a  teaspoonful  every 
four  hours;  older  or  younger  children  in  proportion. 

(k)  Rose  rash,  sometimes  called  false  or  German  measles 
is  a  comparatively  trivial  affection  and  of  very  little  impor- 
tance, for  it  never  has  any  serious  complications  and  lasts 
only  twenty-four  or  forty-eight  hours  in  the  majority  of  cases. 
It  is  often  mistaken  for  measles,  and  one  attack  affords  no 
protection  against  recurrences.  The  eruption  appears  in 
small  rose-colored  spots  or  patches  which  are  not  elevated. 
It  does  not  commence  on  the  head,  but  appears  on  different 
parts  of  the  body.  The  eruption  may  be  preceded  by  head- 
ache, loss  of  appetite,  occasionally  vomiting,  and  more  or 
less  fever  or  chilly  sensations. 

The  affection  of  the  eyes  and  air  passages,  especially 
the  bronchitis  which  is  characteristic  of  measles,  are  wanting 
in  rose  rash,  and  when  we  hear  of  children  having  had 


DISEASES   OF    CHILDREN.  373 

measies  several  times  it  is  reasonable  to  presume  that  it  was 
rose  rash  instead.  This  eruption  hardly  calls  for  treatment, 
but  a  mild  laxative  and  a  regulated  diet  would  fulfill  all 
requirements. 

(I)  Scarlet  fever  or  scarlatina  has  received  its  name  from 
the  color  of  its  eruption.  This  affection  presents  itself  dif- 
ferently in  different  cases.  It  may  be  so  mild  in  its  attack 
that  it  constitutes  a  trifling  ailment  and  again  it  may  be  so 
severe  that  life  is  seriously  threatened,  and  destroyed  in  a 
few  days.  This  has  formed  the  basis  of  dividing  scarlatina 
into  three  varieties,  namely:  simple  scarlatina,  diphtheritic 
scarlatina  and  malignant  scarlatina. 

The  fever,  as  a  rule,  is  notably  higher  than  in  other  erup- 
tive fevers.  The  attack  may  begin  with  a  chill,  nausea  and 
vomiting  and  headache.  There  is  also  bleeding  from  the 
nose  in  a  certain  proportion  of  cases.  The  most  constant 
sign  is  redness  and  more  or  less  swelling  of  the  throat,  either 
with  or  without  a  sense  of  soreness  and  pain  in  the  act  of 
swallowing.  The  stage  of  development  lasts  in  the  average 
twenty-four  hours,  although  exceptionally  it  may  appear  in 
a  few  hours  after  the  first  symptoms  of  the  disease  have  ap- 
peared. The  eruption  often  begins  on  the  back  first,  and 
from  there  rapidly  spreads  over  the  entire  body  in  twenty- 
four  hours.  It  greatly  differs  from  the  eruption  in  measles 
in  not  allowing  any  healthy  or  white  skin  to  intervene  be- 
tween the  red  specks,  but  the  entire  skin  has  a  reddish  blush. 
This  has  given  rise  to  the  expression  boiled  lobster  appearance 
in  scarlatina,  and  indeed  nothing  could  illustrate  the  color 
of  the  skin  better  than  by  comparing  the  one  with  the  other. 
The  eruption  is  sometimes  accompanied  with  a  great  deal  of 
itching  and  burning  and  reaches  its  fullest  development  on 
the  third  day  after  its  first  appearance;  it  lasts  from  four  to 
six  days. 

The  extent  and  redness  of  the  eruption  varies  greatly  in 
different  individuals,  in  some  it  is  very  slight  and  transient 


374  HOME    TREATMENT. 

while  in  others  there  is  not  a  spot  as  large  as  a  dime  which 
is  not  covered.  Yet  a  very  light  attack  in  one  patient  when 
communicated  to  another  individual  may  develop  in  that 
one  a  most  malignant  form.  One  attack  secures  against  a 
recurrence. 

The  throat  affection  seems  to  modify  the  eruption  of  the 
skin  for  in  some  instances  in  which  the  throat  is  very  bad, 
the  skin  eruption  is  comparatively  slight.  There  may  be 
simply  a  little  redness  over  the  tonsils,  extending  more  or 
less  over  the  soft  palate,  or  on  the  other  hand,  the  disease  in 
the  throat  may  become  in  every  respect  equal  to  if  not  iden- 
tical with  the  worst  t\  pe  of  diphtheria.  Some  writers  con- 
sider the  sore  throat  of  scarlatina  and  that  of  diphtheria 
identical,  and  from  a  practical  point  of  view  there  is  certainly 
no  difference,  and  the  very  best  results  are  obtained  when 
all  severe  sore  throats  of  scarlatina  are  treated  precisely  as  if 
they  were  diphtheria;  this  nas  always  been  my  practice. 

The  tongue  is  quite  distinctive  of  the  affection;  early  in 
the  development  of  the  disease  it  is  generally  furred,  but 
later  the  coating  peels  off  in  patches,  and  these  spots  present 
the  appearance  of  a  ripe  strawberry;  sometimes  the  entire 
surface  of  the  tongue  looks  as  if  cayenne  pepper  or  red  sand 
had  been  sprinkled  on  it. 

The  fever  generally  increases  during  the  eruptive  stage, 
and  the  skin  becomes  very  dry  and  hot.  The  pulse  may 
run  up  to  130  to  140  per  minute,  while  the  temperature  runs 
up  as  high  as  106°  Fahrenheit;  this  state  of  affairs  places 
the  patient  in  imminent  danger,  he  now  may  become  restless 
and  even  delirious.  In  a  certain  proportion  of  cases  the  kid- 
neys become  involved  and  albuminuria  is  a  result,  but  this 
usually  passes  off  with  the  improvement  and  recovery  of  the 
patient. 

In  the  third  stage  the  cuticle  begins  to  exfoliate  in  the 
form  of  branny  scales.  In  the  absence  of  serious  complica- 
tions this  stage  marks  the  beginning  of  convalescence;  the 


DISEASES   OF    CHILDREN.  375 

fever  subsides,  the  appetite  returns,  and  the  soreness  and 
redness  of  the  throat  disappear. 

The  treatment  of  this  affection  always  depends  upon  the 
nature  of  the  case.  Simple  scarlatina  requires  no  medical 
treatment;  the  precaution  and  intelligence  which  are  com- 
prised in  good  nursing  supply  ever}7thing  that  is  required. 
There  is  not  the  same  danger  of  the  eruption  striking  in 
with  scarlatina  as  there  is  with  measles,  and  the  patient 
need  not  be  kept  so  warmly  covered.  When  the  fever  runs 
very  high,  sponging  the  surface  with  cool  water  is  very 
grateful  and  reduces  the  temperature.  After  the  eruption 
has  thoroughly  developed,  the  water  for  sponging  off  may 
be  very  cold  without  the  least  danger,  and  this  may  be  re- 
peated as  often  as  comfort  or  the  high  temperature  demands. 
To  relieve  the  burning  and  itching  of  the  skin,  the  entire 
body  should  be  rubbed  over  with  glycerine  night  and  morn- 
ing; this  relieves  the  system  and  makes  the  skin  moist  and  sup- 
ple. If  the  throat  is  only  reddened,  a  teaspoonful  of  chlorate 
of  potash  dissolved  in  a  cupful  of  hot  water  and  when  cold 
used  as  a  gargle  and  a  teaspoonful  of  the  solution  swallowed 
at  the  same  time  every  two  hours  is  all  that  is  necessary. 
The  diphtheritic  scarlatina  is  treated  precisely  similar  to 
and  according  to  the  instructions  laid  down  for  diphtheria 
in  another  part  of  this  work.  Move  the  bowels  freely  with 
the  Femina  laxative  syrup. 

(m)  Chickenpox  has  neither  distressing  symptoms  nor  is 
it  significant  as  regards  danger.  It  is  an  eruptive  fever 
which  occasionally  affects  adults,  but  for  the  most  part 
children.  The  eruption  is  generally  preceded  by  a  slight 
fever  and  nausea,  and  appears  first  on  the  body  and  after- 
wards on  the  scalp  where  it  is  usually  more  abundant. 
There  always  remains  healthy  white  skin  between  the  vesi- 
cles, which  at  first  contain  a  transparent  liquid,  hence  called 
by  the  Germans  waterpox,  which  afterward  becomes  cloudy 
or  opaline.     The  eruption  begins  to  dry  up  from  the  fifth  to 


376  HOME   TREATMENT. 

the  seventh  day  forming  granular  crusts  that  are  sometimes 
followed  by  pitting.  The  disease  is  contagious  and  develops 
twelve  to  seventeen  days  after  the  exposure.  Chickenpox 
claims  no  treatment;  its  only  point  of  interest  is  its  resem- 
blance to  varioloid,  but  as  a  successful  vaccination  guaran- 
tees against  the  latter,  and  as  the  vesicles  of  varioloid  have 
a  central  depression  while  those  of  chickenpox  have  not,  the 
individuality  of  the  affection  is  readily  established. 


CHAPTER  XXXI. 

EMERGENCY  TREATMENT  IN  SUDDEN  ACCIDENTS. 

If  the  author  reviews  his  experience  of  the  last  twenty 
years,  he  recalls  to  memory  innumerable  instances  in  which 
the  lack  of  a  little  special  knowledge,  in  cases  of  sudden  ac- 
cidents, did  not  only  incur  useless  physical  suffering,  but 
cost  lives  which  otherwise  might  have  been  saved.  Knowl- 
edge of  this  nature  is  not  intuitive,  but  must  be  acquired 
by  study.  He  therefore  offers  for  the  guidance  of  the 
intelligent  reader,  common  sense  advice  on  the  immediate 
management  of  accidents  which  are  liable  to  occur  at  almost 
any  moment. 

If  a  child  falls  any  considerable  distance  to  the  ground, 
the  system  receives  a  shock  varying  from  the  slightest  func- 
tional disturbance  to  complete  insensibility. 

In  the  former  case  there  may  probably  be  only  slight 
pallor  of  the  countenance,  the  ideas  become  confused,  there  is 
a  disposition  to  yawn  and  a  feeling  of  nausea.  Young 
children  have  a  disposition  to  sleep,  older  ones  rub  their 
eyes,  stare  wildly  around  and  even  vomit,  but  after  a  short 
time  they  resume  their  accustomed  employment:  these  symp- 
toms illustrate  a  slight  concussion  of  the  brain. 

When  the  injury  is  more  serious  all  the  above  signs  be- 
come aggravated  and  it  may  take  several  hours  before  the 
normal  condition  is  restored. 

The  proper  course  to  pursue  in  all  these  accidents  is  to 
lay  the  patient  on  a  sofa  or  bed,  with  his  head  slightly  ele- 
vated in  a  darkened  chamber  free  from  all  noise  and  con- 
fusion and  let  him  fall  to  sleep.  In  ordinary  cases  reaction 
takes  place  after  a  quiet  slumber.     If  however  the  patient 

(377) 


378  HOME   TREATMENT. 

complains  of  pains  in  the  head  and  there  is  irritability  of 
temper,  the  advice  of  a  competent  physician  becomes  neces- 
sary. 

(a)  Broken  bones  or  fractures  are  defined  to  be  a  destruc- 
tion of  the  continuity  of  one  or  more  of  the  bones  of  the 
body. 

Fractures  are  divided  into  simple  and  compound;  a  sim- 
ple fracture  is  one  in  which  the  bone  alone  is  broken,  and  in 
which  the  skin  or  integument  over  the  seat  of  the  fracture 
remains  perfectly  intact.  A  compound  fracture  is  one  in 
which  the  skin  and  tissues  over  the  fracture  are  lacerated  or 
wounded  so  that  the  ends  of  the  broken  bones  protrude  or 
are  exposed  to  view. 

In  a  case  of  fracture,  no  matter  of  what  variety,  the  first 
object  to  be  accomplished  is  to  carefully  remove  the  patient 
to  a  place  where  he  may  be  in  a  comfortable  position.  If 
the  fracture  is  in  the  arm  or  leg  it  should  be  comfortably 
supported  on  a  pillow  so  as  to  relieve  the  injured  limb  from 
all  strain. 

In  compound  fractures,  the  wound  should  be  carefully 
covered  with  a  soft  clean  compress  which  is  kept  thoroughly 
wetted  with  clean  cold  water  until  the  surgeon  arrives. 

Sometimes  the  circumstances  make  it  necessary  to  remove 
or  transport  a  patient;  then  the  injured  limb  must  be  prop- 
erly supported  so  that  it  will  remain  motionless  on  the  jour- 
ney. In  case  the  arm  is  fractured  the  above  object  is  readily 
accomplished  by  placing  it  in  a  sling  suspended  from  the 
neck.  In  the  case  of  the  lower  extremities  this  object  is 
more  difficult.  The  leg  should  be  wrapped  in  cotton  first, 
or  some  other  soft  clean  substance,  after  which  a  slat  should 
be  placed  on  the  outside  and  inside  of  the  limb,  the  same 
length  as  the  limb;  over  and  around  these  slats  strips  of 
muslin  or  a  bandage  is  wound  so  as  to  keep  them  in  place. 
This  contrivance  forms  a  temporary  or  improvised  splint 
until  the  surgeon  takes  charge  of  the  case. 

(c)  Wounds  are  defined  as  a  recent  sudden  solution  of 


EMERGENCY   TREATMENT.  379 

continuity  in  the  soft  parts  or  flesh  of  the  body.  For  the 
sake  of  convenience  in  description  and  for  practical  purposes, 
wounds  are  divided  into  incised,  lacerated,  contused,  punc- 
tured, and  poisoned  wounds. 

An  incised  wound  is  a  clean  smooth  cut  made  by  a  sharp 
clean-cutting  instrument. 

A  lacerated  wound  is  one  in  which  the  parts  have  been 
torn  asunder  or  in  which  the  instrument  was  blunt  or  dull. 

A  contused  wound  is  one  the  result  of  a  bruise  or  blow 
inflicted  with  a  blunt  object  or  by  a  flat  surface. 

A  punctured  wound  is  one  in  which  the  flesh  is  pierced 
with  a  sharp-pointed  instrument,  like  that  made  with  a 
stiletto  or  bayonet. 

Poisoned  wounds  are  such  as  have  become  infected  any 
time  after  the  receipt  of  the  injury,  or  which  are  the  result 
of  a  bite  or  sting  from  a  reptile  or  insect. 

The  danger  of  wounds  depends  on  their  extent  and 
depth,  and  upon  the  locality  or  organ  in  which  the  wound 
is  situated.  The  external  wounds,  that  is  those  which  admit 
of  inspection,  and  situated  on  the  head,  trunk  or  extremities 
are  of  most  frequent  occurrence,  and  the  most  amenable  to 
treatment. 

The  treatment  of  wounds  has  made  wonderful  progress 
since  the  antiseptic  discoveries  of  the  eminent  surgeon,  Sir 
Joseph  Lister,  and  these  sound  principles  have  materially  in- 
fluenced almost  every  department  of  the  healing  art.  It  was 
he  who  first  showed  how  dust-laden  air  affected  injuriously 
the  exposed  tissues  of  the  wounds;  it  was  he  who  introduced 
all  the  precautions  as  to  cleanliness  of  instruments;  the  dis- 
infection of  hands;  the  change  of  clothing;  and  the  purifi- 
cation of  sponges  and  dressings.  The  magnificent  results  of 
the  practice  of  modern  surgery  are  not  owing  to  the  superior 
skill  of  the  surgeon  of  our  time,  but  to  the  magnificent  con- 
ception of  the  idea  of  cleanliness  from  which  has  grown  the 
entire  superstructure  of  antiseptic  surgery,  culminating  in 
the  grand  triumphs  of  surgical  art.     To  the  question  What 


380  HOME    TREATMENT. 

to  do  with  recent  wounds?  The  answer  now  becomes  self- 
evident;  Keep  them  clean.  The  best  dressing  for  any  clean 
wound  is  its  own  secretion  carefully  protected  from  the  out- 
side world  by  a  fold  of  clean  soft  cloth  or  absorbent  cotton, 
wetted  with  pure  cold  water.  This  is  to  be  kept  in  its  proper 
place  by  means  of  a  bandage,  and  when  it  is  desirable  to 
remove  the  compress,  it  must  first  be  thoroughly  soaked  with 
water  so  as  not  to  tear  or  irritate  the  wound. 

Before  Lister's  great  antiseptic  discovery  it  was  the  gener- 
ally accepted  opinion  that  suppuration  and  pus  were  essential 
to  the  healing  of  wounds;  this  was  an  error  and  the  opposite 
is  now  established  to  be  the  truth.  Pus  prevents  or  rather 
delays  the  wounds  from  healing,  and  suppuration  in  wounds 
is  a  fruitful  source  of  blood  poisoning. 

If  sand,  earth,  dust  or  dirt  has  gotten  into  or  near  the 
wound,  it  must  be  washed  off  with  clean,  fresh  water,  but 
never  employ  soiled  or  infected  clothes  for  that  purpose  for 
these  may  poison  the  wound  and  do  a  great  deal  of  mischief. 
After  the  wound  is  clean  dress  it  in  the  manner  described  in 
a  preceding  paragraph. 

Poisoned  wounds  are  chiefly  punctured.  The  danger  of 
these  wounds  lies  in  the  possibility  that  the  poison  is  absorbed 
by  the  lymphatics  and  veins,  and  conveyed  to  the  heart, 
whence  the  entire  blood  becomes  infected.  To  prevent  this 
a  ligature  should  be  tied  above  the  wound,  by  means  of  a 
strip  of  muslin  or  preferably  an  elastic  suspender,  so  as  to 
check  the  free  return  of  the  blood  by  the  veins  and  lym- 
phatics. After  which  the  poison  should  be  sucked  from  the 
wound,  or  the  wound  should  be  cauterized,  with  carbolic  or  ni- 
tric acid  by  means  of  a  sharp-pointed  stick  dipped  into  the  acid 
and  then  applied  to  the  wound,  or  fired  with  a  red-hot  iron, 
crochet  or  knitting  needle.  The  poison  of  snakes  and  taran- 
tulas is  neutralized  with  an  alkali;  the  most  efficient  seems 
to  be  spirits  of  ammonia,  but  a  strong  solution  of  washing 
or  even  baking  soda  should  be  substituted  when  ammonia  is 
not  at  hand.     I  would  puncture  and  enlarge  the  wound  of 


EMERGENCY  TREATMENT.  381 

the  sting  with  the  point  of  a  sharp  knife  or  scissors,  so  that 
the  alkali  can  come  into  immediate  contact  with  the  injected 
venom ;  the  patient  must  be  given  frequent  drinks  of  whisky, 
brandy  or  strong  wine  until  a  physician  arrives  to  supervise 
further  treatment 

Wounds  inflicted  by  poisonous  insects  like  the  bumble- 
bee, honeybee,  wasp,  hornet,  yellow-jacket  and  mosquitoes 
produce  wounds  which  are  instantly  followed  by  a  sharp, 
pungent,  itching  pain,  and  in  a  few  moments  after  by  a  pale, 
circumscribed,  inflammatory  swelling.  Some  persons  have 
a  peculiarity  in  their  constitution  that  the  poison  of  an  in- 
sect gives  rise  to  exceedingly  alarming  symptoms,  such  as 
palpitation,  nausea,  dizziness,  dimness  of  sight  and  an  in- 
describable sense  of  suffocation.  The  sting  is  sometimes  left 
in  the  skin ;  for  this  the  wound  should  be  carefully  examined, 
and  when  present  drawn  out.  The  most  prompt  and  useful 
application  is  water  of  ammonia,  or  strong  salt  water,  or 
strong  soapsuds.  Turpentine  is  also  a  valuable  application. 
If  the  insect  has  lodged  in  the  throat,  large  quantities  of 
warm  salt  water  and  mustard  must  be  immediately  admin- 
istered until  the  patient  has  vomited  freely,  and  if  there  is 
a  sense  of  suffocation  leeches  and  afterwards  hot  poultices 
should  be  applied  to  the  neck.  If  the  system  has  become 
poisoned,  and  some  of  the  distressing  symptoms  that  were 
above  enumerated  are  present,  the  internal  use  of  whisky 
or  brandy  is  called  for. 

Hemorrhage  is  common  to  all  wounds,  and  the  loss  of 
the  blood  depends  upon  the  size  and  nature  of  the  vessel 
that  is  injured. 

The  bleeding  that  takes  place  in  ordinary  superficial 
wounds  oozes  from  minute  vessels,  the  capillaries,  and  slight 
pressure  temporarily  applied  controls  it.  When  an  artery 
is  wounded,  the  blood  flows  in  intermittent  jets,  or  in  a  run- 
ning pulsating  stream  from  the  vessel.  The  venous  blood 
is  dark  red  and  flows  in  a  continuous  stream  and  not  under 
the  same  pressure  as  that  coming  from  the  arteries,  hence  it 
is  much  easier  controlled. 


382  HOME   TREATMENT. 

The  clotted  blood  with  which  a  wound  may  be  filled,  is 
nature's  means  of  arresting  the  hemorrhage,  and  it  must 
never  be  disturbed  or  washed  off,  lest  this  open  the  blood 
vessels  again  and  thereby  renew  the  bleeding. 

The  arrest  of  hemorrhage  is  accomplished  by  the  appli- 
cation of  cold  or  ice  water,  by  hot  water  and  by  pressure 
upon  the  arteries.  Persons  fainting  from  the  loss  of  blood 
should  always  be  laid  with  their  heads  lower  than  the  body; 
cold  water  should  be  dashed  into  their  faces  so  as  to  restore 
them  to  consciousness.  Moderate  hemorrhage  from  the 
smallest  vessels  and  from  the  veins  generally  ceases  from 
slight  pressure  over  the  wounds  or  by  drawing  or  pressing 
the  edges  of  the  wounds  together.  In  a  very  short  time  the 
blood  coagulates  and  forms  a  temporary  plug  until  the  ves- 
sels themselves  become  permanently  sealed  by  a  similar 
process.  The  pressure  must  often  be  continued  for  a  con- 
siderable time  until  the  object  has  been  attained.  A  folded 
clean  cloth  or  compress  is  laid  over  the  wound  which  is  the 
source  of  the  hemorrhage,  and  this  is  retained  by  means  of  a 
properly  adjusted  bandage.  If  notwithstanding  the  pressure 
exerted  by  the  bandage  or  with  the  hands,  the  scarlet  blood 
saturates  the  cloth  and  continues  to  flow,  it  indicates  that  a 
very  large  vessel  is  wounded,  and  thus  life  may  be  seriously 
threatened  and  in  proportion  to  the  magnitude  of  the 
wounded  vessel,  a  surgeon  should  now  be  summoned  to 
make  a  further  investigation.  Hemorrhage  from  varicose 
veins  of  the  legs  may  be  checked  by  a  compress  fastened 
over  the  site  of  the  wound  by  a  bandage,  but  every  constric- 
tion around  the  waist  or  above  the  knee  by  a  garter  must  be 
loosened.  If  the  patient's  life  is  threatened  from  the  bleed- 
ing, the  limb  must  be  elevated,  and  the  pressure  of  the  com- 
press increased,  or  the  pressure  should  be  exerted  on  the 
trunk  of  the  bleeding  artery  above  the  wound  or  injury. 

(d)  Burns  and  scalds  are  the  most  commonly  fatal  injuries 
which  occur  in  modern  life.  The  extended  use  of  steam 
machinery,  the  universal  employment  of  coal  oil,  the  general 


EMERGENCY   TREATMENT.  383 

use  of  the  phosphorus  and  sulphur  matches,  and  the  flow- 
ing manner  of  woman's  dress  has  materially  increased  the 
liability  of  this  accident.  Of  all  accidents,  burns  involve 
the  victim  in  the  most  agonizing  pain  and  protracted  suffer- 
ing. Burns  are  liable  to  serious  complications;  the  obstinacy 
to  the  healing  of  vast  ulcerated  surfaces,  or  the  lifelong 
mutilation  to  which  they  condemn  the  unhappy  patient,  the 
rapid  draft  they  make  on  the  patient's  strength,  and  the 
danger  of  abscess  and  ulceration  of  internal  vital  organs 
which  eventually  destroy  life. 

These  injuries  have  been  classified  into  three  divisions: 
First  degree,  superficial  skin  irritation.  Second  degree, 
cutaneous  inflammation.  Third  degree,  devitalization  of 
the  skin  or  deeper  parts,  or  carbonization  of  a  mem- 
ber, or  the  entire  body.  The  first  degree  is  only  a  super- 
ficial redness,  fading  without  any  definite  edge  into  the 
natural  skin.  This  may  be  produced  by  the  sudden  and 
momentary  application  of  flame  over  a  larger  portion  of  the 
body,  from  an  explosion  of  gas.  The  local  injury  is  not 
dangerous,  and  the  epidermis  remains  to  protect  the  surface 
of  the  true  skin  until  a  new  layer  is  produced,  as  the  injured 
one  peels  off.  This  hardly  calls  for  any  other  treatment  but 
one  or  several  applications  of  sweet  oil.  In  the  second 
degree,  the  local  injury  has  penetrated  a  little  deeper,  and 
the  sudden  congestion  of  blood  to  the  surface,  raises  the 
epidermis  from  the  cutis  in  blisters  filled  with  the  serum  of 
its  vessels.  Here  there  is  a  more  serious  condition,  and 
indeed  dangerous  in  proportion  to  the  extent  of  surface  that 
has  become  involved.  Skirts  draped  largely  with  lace,  and 
those  made  of  cheese  cloth,  swiss,  and  other  guazy  material 
are  of  a  very  inflammable  nature,  and  when  once  ignited 
blaze  into  a  flame  that  is  almost  sure  to  consume  the  material 
before  it  can  be  extinguished,  so  that  it  has  been  deemed 
advisable  on  the  German  stage,  to  first  saturate  these  mate- 
rials in  a  solution  of  sulphate  of  ammonia  to  make  them 
non-inflammable;  this  does  not  interfere  with  ironing,  nor 


384  HOME   TREATMENT. 

with  the  texture  or  color  of  the  fabric.  Another  source  of 
scalds  and  burns  is  the  wash  boiler  or  tub  on  the  floor,  with 
hot  or  boiling  water  in  it,  so  that  little  children  stumble  or 
reach  into  it.  Vessels  filled  with  hot  water  or  other  fluids 
standing  on  tables  or  on  stoves  within  reach  of  little  children, 
who  innocently  pull  the  vessel  down,  pouring  its  scalding 
contents  over  them,  is  another  cause  of  numerous  accidents. 

The  best  course  to  pursue  when  skirts  or  clothing  are  on 
fire  is  to  roll  the  victim,  so  as  to  smother  the  flames;  but  the 
patient  herself  has  rarely  enough  presence  of  mind  to  do  this. 
She  will  run  for  help,  thus  fanning  the  flames,  the  very  worst 
thing  she  can  do.  Take  the  nearest  blanket  or  quilt,  or  if 
that  is  not  at  hand,  take  an  overcoat  or  wrap;  wrap  this 
around  the  burning  person  and  throw  her  to  the  floor  and 
roll  her  until  the  flames  are  smothered.  Then  get  some 
cold  water  and  pour  it  on  the  smoldering  clothes  until  they 
are  thoroughly  saturated,  for  the  hot  charred  clothing  burns 
into  the  flesh.  In  scalding  from  hot  water  or  steam  the  cloth- 
ing should  be  cooled  off  in  the  same  manner.  Cold  water 
must  be  poured  over  the  hot  and  steaming  clothes  from  head 
to  foot,  and  thus  the  further  action  of  the  heat  is  suddenly 
checked.  The  patient  should  now  be  carefully  removed  to 
a  warm  room  and  laid  in  a  blanket,  on  the  table  or  floor.  If 
he  complains  of  thirst  give  a  cupful  of  warm  tea  or  a  warm 
whisky  toddy. 

Visitors  and  strangers  should  now  be  requested  to  leave 
the  room  and  the  clothing  should  be  removed  from  the  body 
with  the  greatest  care.  The  scissors  or  a  sharp  knife  should 
be  used  to  cut  away  the  garments,  so  as  to  avoid  all  possible 
straining  and  dragging  on  the  patient.  The  blisters  must 
not  be  torn,  and  where  they  are  very  tense  they  can  be 
pricked  with  a  sharp  needle,  so  as  to  allow  the  escape  of  the 
serum.  The  epidermis  forms  the  best  protection  for  the 
cutis,  and  where  the  skin  is  stuck  to  the  linen  do  not  tear 
this  off,  but  allow  it  to  remain  and  cut  with  a  sharp  scissors 
around  it.    The  application  of  cold  water  generally  increases 


EMERGENCY  TREATMENT.  385 

the  suffering,  but  sweet  oil,  lard  oil,  vaseline,  castor  and 
china  nut  oil  will  answer  for  the  emergency  or  until  a  more 
suitable  dressing  can  be  obtained,  after  which  the  surface 
should  be  covered  with  cotton  batting  to  exclude  the  air. 
A  very  useful  application  is  a  mixture  of  equal  parts  of  lime 
water  and  sweet  oil  or  linseed  oil.  Carbolized  sweet  oil  is 
another  useful  dressing  and  superior  to  lime  water  liniment; 
it  is  made  in  proportion  of  half  an  ounce  of  carbolic  acid  to 
one  pint  of  sweet  oil;  either  of  the  above  preparations  can  be 
poured  over  the  burned  surface  and  then  it  should  be  cov- 
ered with  cotton  batting,  or  small  pieces  of  soft  linen  cloth 
can  be  dipped  and  saturated  in  the  oil  and  then  applied 
over  the  burns.  The  advice  of  a  physician  should  be  sought 
in  view  of  the  dangerous  complications  that  may  occur  from 
extensive  burns. 

(e)  Frostbite  is  the  result  of  exposure  to  cold,  and  in  cer- 
tain regions  during  the  winter  months  a  considerable  num- 
ber are  liable  to  this  accident.  But  extreme  cold  weather  is 
not  alone  responsible  for  frostbite;  very  often  this  accident 
occurs  in  moderately  cold  weather,  for  instance,  if  persons 
exhausted  from  hunger  or  fatigued  from  long  travels  or 
stupefied  by  alcoholic  drink  lay  themselves  down  and  fall 
asleep,and  a  cold  wind  blows  over  them  which  withdraws  the 
bodily  heat,  the  same  effects  are  accomplished  on  the  system. 

The  first  effect  of  dry,  cold  air  is  a  sense  of  numbness 
and  weight,  with  a  peculiar  prickling  or  tingling,  and  a  rush 
of  blood  to  the  surface,  giving  the  skin  a  lively  reddish  ap- 
pearance. If  the  cold  is  maintained  for  any  length  of  time 
the  blood  leaves  the  surface,  which  becomes  now  of  a  pale 
and  whitish  aspect,  forming  a  striking  contrast  to  the 
previous  redness.  When  the  cold  is  suddenly  applied  and 
very  intense,  the  skin  exhibits  a  mottled  appearance,  which 
is  due  to  the  presence  of  congealed  blood  in  the  subcutane- 
ous veins. 

Moist  cold  has  a  similar  effect  on  the  living  tissues  to 
dry  cold.  If  the  hand  is  immersed  in  iced  water  the  blood 
25 


386  HOME   TREATMENT. 

rushes  immediately  to  the  surface,  so  that  the  color  of  the 
skin  increases,  which  is  followed  by  a  marked  degree  of 
numbness,  and  an  unpleasant  burning  and  tingling  sensa- 
tion. A  reaction  comes  on  in  a  short  time,  the  blood  quits 
the  surface,  and  the  skin  becomes  bleached  and  contracts, 
the  tissues  underneath  also  shrink  and  become  painful. 
There  is  no  difference  in  the  effect  of  either  moist  or  dry  cold, 
only  that  the  former  is  more  penetrating  and  its  effects  are 
sooner  apparent.  Those  parts  of  the  body  that  are  more  di- 
rectly exposed  and  in  which  the  circulation  is  not  much  pro- 
tected by  fatty  tissue,  suffer  the  most  from  the  effects  of  cold; 
after  exposure  for  an  unusual  length  of  time  the  toes,  feet, 
heels,  fingers,  hands,  nose,  and  ears,  together  with  the  lips 
and  cheeks  are  for  this  reason  oftener  affected  than  other 
parts  of  the  body.  Persons  whose  constitutions  are  broken 
down  by  intemperance,  starvation  and  other  privations 
which  lower  the  power  of  resistance  are  more  susceptible  to 
this  accident. 

The  first  effect  of  cold  in  the  general  system  is  bracing 
and  stimulating;  an  agreeable  glow  is  felt  over  the  surface 
of  the  body  and  one  feels  strengthened  and  exhilarated. 
But  if  the  cold  temperature  is  unusually  prolonged  this 
agreeable  sensation  is  changed  into  one  of  pain  and  drowsi- 
ness; the  brain  becomes  inactive  as  if  under  the  influence  of 
a  powerful  opiate  or  narcotic,  and  the  desire  to  go  to  sleep  is 
so  strong  that  it  requires  the  greatest  effort  to  keep  awake. 
To  yield  to  this  inclination  to  sleep  would  result  in  slumber 
that  knows  no  waking,  for  the  blood  would  now  rapidly  accu- 
mulate in  the  internal  organs,  the  breathing  would  become 
irregular  and  spasmodic,  the  nervous  functions  would  soon 
be  suspended  and  death  would  ensue  from  general  paralysis. 
An  individual  thus  exposed,  so  as  to  have  become  drowsy  or 
unconscious  and  then  suddenly  brought  into  a  hot  room  is 
likely  to  die  from  congestion  of  the  brain  and  lungs,  or  if  he 
should  revive  for  a  short  time,  the  frost-bitten  parts  will  be 
stricken  with  mortification.    Professor  Samuel  D.  Gross  says: 


EMERGENCY   TREATMENT.  387 

""The  treatment  of  frostbite  requires  no  little  judgment  and 
adroitness  to  conduct  it  to  a  successful  issue.  The  great  in- 
dication is  to  recall  the  affected  parts  gradually  to  their  nat- 
ural condition  by  restoring  circulation  and  sensibility,  in 
the  most  gentle  and  cautious  manner,  not  suddenly,  or  by 
severe  measures.  The  first  thing  to  be  done  is  to  immerse 
them  in  iced  water,  or  rub  them  with  snow,  the  friction  be- 
ing made  as  carefully  and  lightly  as  possible,  lest  overaction 
be  produced,  as  they  are  necessarily  greatly  weakened.  If 
no  ice  or  snow  is  at  hand,  the  coldest  well  water  that  can  be 
procured  must  be  used;  and  if  immersion  is  inconvenient, 
wet  cloths  are  applied,  with  the  precaution  of  maintaining 
the  supply  of  cold  and  moisture  by  constant  irrigation. 
Moderate  reaction  is  aimed  at  and  fostered.  All  warm  ap- 
plications, whether  dry  or  moist,  are  scrupulously  refrained 
from;  the  patient  must  not  approach  the  fire,  nor  immerse 
his  limbs  in  hot  water,  or  even  be  in  a  warm  room.  Atten- 
tion to  these  precepts  must  on  no  account  be  disregarded, 
as  its  neglect  would  be  almost  certainly  followed  by  morti- 
fication or  other  disastrous  consequences." 

(/)  Drowning  or  the  submersion  of  an  individual  until 
life  is  destroyed  by  suffocation  is  not  an  uncommon  accident. 
"The  immediate  cause  of  death  in  drowning,"  says  Dr.  Gross, 
^'is  suffocation  or  insufficiency  of  air.  Respiration  being  thus 
arrested,  the  blood  is  unaerated  and  consequently  unfitted 
for  life,  although  the  circulation  may  go  on  for  a  short  time 
after  breathing  has  completely  ceased." 

The  Navarino  sponge  divers  whose  occupation  has  ac- 
customed them  to  live  under  water  the  extreme  limit,  aver- 
age only  seventy-six  seconds,  while  the  Ceylon  pearl  divers 
seldom  remain  under  water  with  impunity  more  than  two- 
thirds  of  that  time. 

Dr.  Gross  says:  "The  period  at  which  a  person  after  sub- 
mersion may  be  resuscitated  varies  very  much  in  different 
cases  and  under  different  circumstances.  In  some  cases,  for 
reasons  not  always  explicable,  recovery  is  found  to  be  im- 


388  HOME    TREATMENT. 

possible  at  the  end  of  one  minute.  The  chances  are  never 
good  after  submersion  of  twice  this  length  of  time,  especially 
when  the  water  and  the  air  are  both  uncommonly  cold. 

"The  treatmentof  apncea  from  drowning  must  be  prompt 
and  decided.  Every  moment  of  time  is  most  precious.  The 
body  being  removed  from  the  water  to  a  dry  place,  is  imme- 
diately stripped,  wiped,  and  covered  with  a  blanket, especially 
in  cold  weather.  The  mouth,  nostrils  and  throat  arecleared 
of  mucus,  froth,  and  any  other  substances  likely  to  interfere 
with  the  admission  of  air  to  the  lungs;  the  tongue  is  to  be 
pulled  out  at  the  corner  of  the  mouth,  and  prevented  from 
falling  back  upon  the  glottis;  ammonia  is  rapidly  passed  to 
and  fro  under  the  nose;  and  the  body  is  stretched  out  at 
full  length  with  the  face  downwards,  the  forehead  resting 
upon  one  arm,  for  the  purpose  of  allowing  any  water  that 
may  be  in  the  stomach  and  air  passages  to  escape  by  the 
mouth  and  nose.  If  these  means  do  not  speedily  revive  the 
patient,  artificial  respiration  is  instituted.  For  this  purpose, 
the  body  being  placed  upon  its  back,  with  the  head  slightly 
elevated,  the  arms,  grasped  just  above  the  elbows,  are  carried 
outwards  and  upwards  from  the  chest  almost  perpendicu- 
larly, and  retained  in  this  position  for  about  two  seconds, 
the  object  of  the  procedure  being  designed  to  promote  the 
introduction  of  air  into  the  lungs  as  in  natural  breathing. 
They  are  then  lowered  and  brought  closely  to  the  sides  of 
the  chest,  where  they  are  held  for  the  same  length  of  time, 
to  expel  the  air,  the  effect  being  aided  by  pressure  applied 
to  the  inferior  and  lateral  portions  of  the  chest.  These  alter- 
nate movements  of  elevation  and  depression  from  twelve  to 
fourteen  times  a  minute,  and  are  performed  with  all  possible 
gentleness.  As  soon  as  signs  of  life  are  observed,  dry  warmth 
should  be  applied  to  the  extremities,  the  region  of  the  heart, 
loins,  and  abdomen,  a  little  brandy  and  water  being  admin- 
istered, or  if  deglutition  be  impracticable,  thrown  into  the 
rectum." 

(g)  Poisons  and  their  antidotes  form  an  important  sub- 


EMERGENCY  TREATMENT.  389 

ject  for  our  consideration,  because  many  of  the  poisons  are 
among  the  most  useful  remedies.  The  daily  accounts  in 
the  public  press  of  serious  and  fatal  mistakes  in  the  admin- 
istration of  medicines,  are  always  due  to  carelessness  and  very 
often  to  criminal  negligence. 

No  package  or  bottle  should  be  kept  about  the  house 
without  its  proper  label. 

Those  that  contain  poisonous  drugs  or  chemical  prepara- 
tions should  be  plainly  marked  Poison,  besides  the  name  ot 
their  contents. 

Vials  or  packages  containing  poisonous  drugs  or  chem- 
icals must  not  be  kept  on  the  same  shelf  and  near  those 
medicines  that  are  comparatively  harmless. 

Always  look  at  the  label  twice;  once  before  the  contents 
are  poured  out,  and  a  second  time,  before  the  dose  is  swal- 
lowed. Never  take  medicine  in  the  dark,  in  the  belief  that 
you  are  certain  of  the  right  vial  and  locality;  many  a  sad 
accident  has  occurred  from  this  venture. 

Sulphuric,  nitric,  and  muriatic  acid  cause  great  heat  and 
a  sensation  of  burning  pain  from  the  mouth  down  to  the 
stomach.  Acids  are  neutralized  by  alkalies,  hence  one  tea- 
spoonful  of  washing  soda  or  two  teaspoonfuls  of  bicarbonate 
of  soda  dissolved  in  a  pint  of  water  should  be  drunk  as  soon 
as  possible:  chalk  or  powdered  magnesia  mixed  with  water 
will  also  answer  the  purpose. 

Oxalic  acid  is  frequently  mistaken  for  Epsom  salts;  lime 
water,  chalk  or  magnesia  mixed  with  water  and  taken  in 
large  quantities  are  antidotes:  then  administer  emetics,  which 
act  more  quickly  if  the  stomach  is  filled  with  fluids;  some- 
times the  finger  run  down  the  throat  will  excite  quick  and 
sufficient  vomiting. 

Creosote  and  carbolio  acid  benumb  the  stomach  so  that 
emetics  usually  will  not  act.  and  large  quantities  of  sweet  oil 
or  castor  oil  should  be  first  drunk;  I  prefer  the  former  be- 
cause from  one  to  two  pints  of  it  can  be  taken;  after  which 
lime  water  or  a  solution  of  Glauber  salt  (sulphate  of  sodium) 


390  HOME   TREATMENT. 

should  be  taken;  the  latter  is  especially  recommended  as> 
neutralizing  carbolic  acid.  When  circumstances  make  it 
possible  the  stomach  pump  or  india  rubber  siphon  tube 
should  be  at  once  employed. 

Alkalies,  for  example,  caustic  potassa,  soda,  lye,  strong  so- 
lution of  ammonia,  earths  and  lime  are  neutralized  by  drink- 
ing vinegar  or  lemon  or  lime  juice;  afterwards  milk  in  water., 
and  flaxseed  tea. 

Arsenic:  Give  the  white  of  eggs,  lime  water  or  chalk  and 
water;  tablespoonful  doses  of  carbonate  of  iron,  mixed  with 
water,  or  calcined  magnesia  in  the  same  manner,  then  evac- 
uate the  stomach  with  an  ipecac  emetic. 

Corrosive  sublimate:  Give  white  of  eggs,  or  wheat  flour 
mixed  with  water;  afterwards  give  an  emetic. 

Alcohol:  First  cleanse  out  the  stomach  writh  an  emetic, 
then  dash  cold  water  on  the  head  and  give  frequent  doses  of 
aromatic  spirits  of  ammonia  in  wrater. 

Charcoal  or  coal  gas  poisoning:  Remove  the  patient  into 
the  open  air,  dash  cold  water  on  the  head  and  body  and 
stimulate  by  passing  ammonia  to  and  fro  under  the  nostrils, 
at  the  same  time  rubbing  the  chest  briskly. 

Lead  :  White  lead  and  sugar  of  lead  should  first  be  treated 
with  alum  emetic,  afterwards  a  cathartic  of  castor  oil  or 
Epsom  salt. 

Nitrate  of  silver  (lunar  caustic) :  Give  a  strong  solution 
of  common  salt,  and  then  emetics. 

Prussic  acid  or  cyanide  of  potassium.  For  this  no  cer- 
tain antidote  exists,  and  it  destroys  life  so  suddenly  as  scarcely 
to  allow  of  use  if  we  had  one.  When  there  is  time  chlorine 
in  solution  has  been  recommended,  also  water  of  ammonia 
and  cold  affusions. 

Opium,  laudanum  and  morphine  require  the  same  anti- 
dote. If  the  patient  can  swallow  an  emetic  should  be  given; 
twenty  grains  of  sulphate  of  zinc  and  a  teaspoonful  of  pow- 
dered ipecac  mixed  in  a  draught  of  water  should  be  given 
every  twenty  or  thirty  minutes  until  vomiting  is  insured. 


EMERGENCY  TREATMENT.  391 

A  mixture  of  half  teaspoonful  of  mustard  and  a  tablespoon- 
ful  of  salt  dissolved  in  a  pint  or  quart  of  warm  water  is 
another  efficient  emetic  in  these  cases.  If  swallowing  is 
impossible  the  stomach  pump  must  be  used.  When  the 
stomach  is  cleansed  out  give  strong  coffee  and  acid  drinks, 
dash  cold  water  on  the  head  and  keep  the  patient  walking. 

Belladonna  and  black  henbane:  Give  emetics,  and  after- 
wards a  dose  of  paregoric,  and  a  hot  whisky  toddy,  or  a 
cupful  of  strong  tea. 

Nux  Vomica  and  strychnine  have  no  reliable  chemical 
antidote;  emetics  shouldfirst  be  given, or  the  stomach  washed 
out  with  a  siphon  tube  or  stomach  pump.  Chloroform  must 
be  employed  to  control  the  spasms,  then  alcoholic  stimulants 
should  be  freely  administered. 

Aconite,  digitalis,  hemlock,  lobelia,  cantharides,  poison- 
ous mushrooms  or  toadstools,  etc.,  have  no  certain  antidotes. 
Emetics  should  be  immediately  given  when  any  of  them 
are  known  to  have  been  taken.  Animal  charcoal  is  recom- 
mended to  absorb  and  render  harmless  organic  poisons  in 
the  stomach;  teaspoonful  doses  mixed  with  water  should  be 
given  repeatedly,  and  for  those  drugs  least  depressing  in 
their  action  castor  oil  is  also  recommended. 

When  a  prompt  emetic  is  urgently  demanded  and  no 
drugs  of  any  kind  are  at  hand,  large  quantities  of  tepid  wa- 
ter should  be  drunk,  say  half  gallon  to  a  gallon;  this  distends 
the  stomach  mechanically,  and  by  titillating  the  throat 
prompt  and  effective  vomiting  may  be  excited;  this  may 
be  repeated  as  often  as  necessary  and  the  stomach  thoroughly 
washed  out. 


CHAPTER  XXXII. 

SOMETHING    ABOUT    DIET. 

It  has  been  truthfully  said  that  "many  persons  dig  their 
graves  with  their  teeth,"  but,  that  improper  feeding  causes 
many  a  grave  to  be  dug  is  also  true. 

So  never  feel  sorry  or  disappointed  when  the  family 
physician  makes  a  professional  visit,  and  fails  to  write  a 
prescription,  but  instead,  gives  you  instruction  in  the  art  of 
feeding  and  nursing  the  patient. 

Food  and  stimulants  support  the  strength  of  the  system 
until  the  struggle  between  health  and  disease  or  between 
life  and  death  is  overcome,  and  thus  cure  the  patient  by 
not  allowing  him  to  starve..  There  is  a  large  group  of  dis- 
eases for  which  there  are  no  acknowledged  remedies,  and 
in  which  a  properly  selected  and  regulated  diet  forms  the 
mainstay  of  successful  treatment.  This  should  be  combined 
with  healthy,  clean  rooms,  proper  ventilation,  and  other  hy- 
gienic means  which  may  suggest  themselves  to  the  intelli- 
gent practitioner. 

The  patient's  fancy  for  this  or  that  article  of  diet  is  no 
index,  as  a  rule,  of  what  is  best  suited  for  him;  invalid  ap- 
petites and  cravings  are  abnormal;  they  are  like  tliat  of  the 
chlorotic  girl  who  eats  chalk  and  slate  pencils,  instead  of 
wholesome  food  and  some  preparation  of  iron. 

An  aversion  to  food  is  also  no  criterion  of  the  patient's 
need  for  nourishment,  for  the  sense  of  taste  is  generally 
blunted  or  perverted.  The  desire  for  food  is  lost  in  all  dis- 
eases of  a  catarrhal  nature  of  the  mouth  or  stomach,  and 
in  those  that  are  characterized  by  high  temperature.  In 
t}'phoid  fever  and  diseases  of  a  typhoid  nature  this  is  always 
the  case. 

(392) 


SOMETHING   ABOUT   DIET.  393 

With  children  this  aversion  to  food  is  greater  and  more 
general  than  with  adults;  and  it  must  be  made  a  rule  that 
their  refusal  to  take  nourishment  must  not  be  extended 
beyond  several  days,  otherwise  they  fail  so  rapidly  in  con- 
junction with  the  disease  as  to   perish  from  exhaustion. 

The  repugnance  to  food  arises  from  abnormal  conditions 
that  are  generally  localized  in  the  mouth  and  especially  in 
the  parts  of  the  tongue  which  are  supplied  by  the  nerves  of 
taste;  these  nerves  are  the  lingual  branch  of  the  trifacial  and 
the  glasso-pharyngeal.  But  notwithstanding  that  the  food 
is  almost  tasteless,  when  it  gets  into  the  stomach  it  is 
retained  and  properly  digested  and  the  patient  feels  better 
for  having  taken  it.  An  appetite  can  be  thus  cultivated, 
and  after  a  few  days  of  coaxing  or  perhaps  of  forcible  feed- 
ing, which  in  children  who  are  failing  rapidly  becomes 
necessary,  in  order  to  save  them,  the  taste  and  desire  for  nour- 
ishment become  natural  or  restored.  Quite  often  patients 
beg  and  plead  not  to  be  given  food;  but  in  wasting  diseases 
it  should  be  insisted  that  some  at  least  should  be  taken  (al- 
ways liquid  of  course),  and  when  they  are  sufficiently  ra- 
tional they  will  always  afterward  admit  that  the  nourish- 
ment did  them  good. 

Liquid  food  or  nourishment  and  no  other  is  suitable  for 
a  sick  person ;  an  invalid  can  drink  food  when  it  would  be 
impossible  for  him  to  swallow  solid  material.  I  have  often 
seen  the  whim  of  patients  who  craved  meat  indulged ;  they 
got  a  juicy  porterhouse  steak  with  the  understanding  that 
it  was  to  be  thoroughly  masticated  before  swallowing. 
As  a  rule,  the  patient  is  disappointed  with  his  own  bill 
of  fare,  and  after  trying  oqp  or  two  mouthfuls  orders 
the  meat  taken  away  with  the  remark  that  it  is  as  dry 
as  a  chip.  But  this  same  person  will  drink  a  milk  punch, 
a  thin  gruel  with  the  yellow  or  all  of  an  egg  beaten  into  it, 
with  some  degree  of  relish;  salt  should  always  be  added  and 
indeed,  as  much  as  the  taste  will  permit,  but  sugar  should 
be  used  as  sparingly  as  possible.     Salt  is  what  is  needed 


394  HOME    TREATMENT. 

above  all  other  seasoning ;  the  system  requires  the  chlorides 
for  they  are  wasted  in  fevers,  but  even  in  health,  the  chlorides 
are  very  essential  and  salt  is  the  best  one  we  have;  salt  is 
the  source  of  the  hydrochloric  acid  in  the  stomach  and  one 
of  the  most  important  factors  in  albuminous  digestion. 

The  saliva  is  not  secreted  in  sufficient  quantity  in  fever 
to  allow  insalivation  of  food,  or  to  moisten  the  solid  morsel 
sufficiently  to  permit  its  being  swallowed  without  a  choking 
sensation  as  it  glides  into  the  stomach.  A  person  prostrated 
by  disease  has  not  the  strength  to  masticate  solid  food  and 
that  is  another  reason  why  liquid  food  is  to  be  given. 

The  famous  physiologist,  Dr.  E.  Brown-Sequard,  is  the 
author  of  a  method  for  feeding  the  sick  peculiarly  his  own, 
namely, that  of  administering  small  quantitiesof  food  atshort 
intervals.  He  would  give  a  glassful  of  milk  punch  in  table- 
spoonful  doses,  repeating  every  ten  or  fifteen  minutes;  this 
method  is  advised  for  the  treatment  and  cure  of  dyspepsia, 
anaemia,  chlorosis,  nervous  diseases  and  even  organic  diseases 
of  the  stomach.  No  particular  kind  of  food  was  selected  for 
this  treatment;  butter,  milk,  cheese,  and  meats,  bread  and 
potatoes  were  alike  to  be  given  in  small  quantities  and  at 
short  intervals.  One  or  two  mouthfuls  even  to  be  eaten  at 
a  time,  and  then  repeated  in  ten  or  fifteen  minutes,  until 
thirty  to  forty  ounces  are  consumed  daily.  This  system 
never  became  a  recognized  expedient,  it  is  wrong  in  theory, 
and  certainly  in  practice;  while  it  may  be  applicable  in 
isolated  cases,  they  would  be  so  very  few  that  this  method 
of  feeding  forms  the  exception  and  not  the  rule. 

Cases  are  frequently  met  with,  especially  in  infants  and 
older  children  whose  digestion  has  been  completely  ruined  by 
being  fed  too  often.  These  cases  are  not  really  overfed,  be- 
cause the  entire  amount  in  the  twenty-four  hours,  does  not 
exceed  the  requisite  quantity;  but  giving  the  food  in  driblets 
and  at  short  intervals,  causes  lactic  fermentation,  or  in  plain 
English,  the  food  sours  on  the  stomach  and  does  not  digest, 
as  it  would  do  if  a  proper  time  were  interposed  between  each 


SOMETHING   ABOUT   DIET.  395 

feeding.  As  soon  as  the  patients  are  fed  at  regular  and  longer 
intervals,  say,  from  two  to  four  hours,  the  indigestion  corrects 
itself.  During  the  interval,  between  the  time  set  for  feeding, 
the  children  will  naturally  cry ;  this  is  interpreted  by  the 
mother  or  nurse  as  a  sign  of  hunger,  but  nothing  is  oftener 
further  from  the  truth.  The  child  cries  generally  for  one  of 
three  reasons:  one  of  these  may  be  that  it  wants  to  be  taken 
up,  and  dandled  or  rocked,  to  which  previous  indulgences 
have  accustomed  it;  or  it  may  have  pain  in  the  stomach  and 
bowels  as  a  natural  result  of  indigestion  or  flatulence;  or  the 
child  may  cry  from  thirst  or  a  sensation  of  dryness  in  the 
mouth  and  throat;  in  any  event,  additional  food  would  only 
prove  injurious.  There  is  no  objection  against  giving  nurs- 
lings cold  water  between  their  meals  when  they  are  thirsty 
or  feverish,  but  warm  aromatic  tea  is  so  very  much  superior 
that  I  consider  it  one  of  the  essentials  of  the  nursery.  I  mean 
fennel  seed  tea,  of  which  a  sufficient  quantity  should  be  pre- 
pared every  morning  to  last  twenty-four  hours ;  this  should 
be  strained  and  sweetened,  then  set  aside  for  further  use. 
When  the  child  is  restless,  between  meals,  some  of  the  tea 
should  be  warmed,  and  given  from  the  nursing  bottle  until 
it  is  satisfied,  for  the  tea  soothes  the  pain,  quenches  the  thirst 
and  dispels  the  flatus. 

There  are  also  physiological  reasons  for  these  longer  in- 
tervals between  nursing;  they  allow  the  stomach  sufficient 
time  to  dispose  of  its  contents  before  another  mess  is  given 
to  disturb  the  digestion  of  former  food,  which  is  as  yet  incom- 
plete. There  is  another  immense  advantage  in  having  the 
length  of  time  between  two  meals  from  two  to  four  hours; 
it  allows  time  for  medication  and  other  necessary  manage- 
ment of  the  sick,  for  sponging  off  with  cold  water  in  fevers, 
and  many  other  things  which  are  necessary  for  the  patient's 
comfort  and  convalescence,  and  which  can  only  be  carried 
out  between  the  times  the  nourishment  is  given.  A  memo- 
randum should  be  kept  in  the  sick  room  and  the  time  and 
hour  noted  when  everything  becomes  due  in  proper  order; 
this  avoids  confusion  and  lessens  labor. 


396  HOME    TREATMENT. 

Digestion  is  the  solution  of  the  food  in  the  stomach  for 
purposes  of  nutrition.  Nitrogenous  materials,  egg,  meat, 
muscle  are  digested  principally  in  the  stomach,  but  not  en- 
tirely so,  because  the  particles  of  albuminous  food  which 
pass  from  the  stomach  into  the  upper  portion  of  the  small 
intestine  come  into  contact  with  the  pancreatic  fluid,  which 
is  the  digestive  agent  for  fats  and  starches,  but  which  pos- 
sesses also  powerful  digestive  properties  for  nitrogenous  or 
albuminous  substances  and  even  in  a  greater  degree  than 
the  gastric  juice  of  the  stomach,  which  has  a  strong  acid  re- 
action, while  the  pancreatic  juice  has  an  alkali  reaction; 
here  is  a  very  interesting  illustration  how  similar  digestive 
processes  are  accomplished  under  opposite  chemical  condi- 
tions. The  intelligent  reader  must  not  fail  to  observe,  from 
what  has  been  said,  that  there  are  two  distinctly  different  di- 
gestive processes,  namely  one  going  on  in  the  stomach  and 
another  equally  as  important  taking  place  in  the  small  intes- 
tines. 

Pepsin  is  the  active  principle  of  the  gastric  juice,  held 
in  solution  in  a  clear  colorless  liquid,  principally  water;  it 
has  a  sour  taste  and  a  peculiar  characteristic  sour  smell. 
The  length  of  time  required  by  the  gastric  fluid  to  dissolve 
the  food  depends  greatly  upon  the  minuteness  of  the  divis- 
ion of  the  solid  substances  to  be  acted  upon,  as  well  as  upon 
the  quantity  and  quality  of  the  peptic  fluid. 

The  pepsin  changes  the  physical  properties  of  nitrog- 
enous substances  so  as  to  make  them  soluble  in  water  in 
any  proportion  and  when  the  albuminoids  have  acquired 
this  property  they  are  termed  peptones;  peptones  are  simply 
nitrogenous  food  which  has  been  modified  to  fit  it  for  ab- 
sorption and  nutrition  of  the  body. 

In  the  tissues  of  the  body  there  are  continual  changes 
going  on,  termed  in  technical  language  tissue  metamorpho- 
sis; the  waste  products  that  are  thus  formed  constitute  a 
group  of  highly  nitrogenized  substances,  which  in  a  healthy 
condition  of  the  system   are  eliminated  by  the  kidneys. 


SOMETHING    ABOUT   DIET.  81)7 

These  nitrogenized  products  are  urea,  urate  of  soda  and  uric 
acid;  the  accumulation  of  any  of  these  substances  in  the 
blood  gives  rise  to  disease;  the  former  is  the  cause  of  uraemia 
and  ursemic  convulsions,  and  the  latter  have  been  detected 
in  the  blood  and  exudations  in  cases  of  gouty  and  rheumatic 
disease.  The  characteristic  gouty  deposit  is  urate  of  soda, 
due  to  an  excess  of  nitrogenous  elements  of  the  blood.  An 
excess  of  uric  acid  constitutes  a  disease  which  is  first  recog- 
nized by  a  reddish  crystalline  sediment  in  the  urine;  the 
term  lithiasis  has  been  employed  to  denote  this  peculiarity. 
These  lithates  are  always  to  be  found  in  the  urine  of  high  liv- 
ers and  are  due  to  an  excessive  consumption  of  nitrogenous 
food.  The  great  English  authority,  Dr.  Murchison,  looks 
upon  the  excessive  production  of  uric  acid,  or  lithic  acid,  as 
it  is  sometimes  called,  as  due  to  one  of  two  causes  and  some- 
times to  both,  namely  to  the  excessive  consumption  of  nitrog- 
enous food,  or  to  an  inability  of  the  liver  to  perform  its  duty, 
which  among  other  things  is  to  dispose  of  the  nitrogenous 
waste  products.  From  this  point  of  view  lithates  or  brick 
dust  deposits  in  the  urine  are  no  sign  that  the  kidneys  are 
deranged,  but  quite  the  reverse  may  be  true  when  the  kidneys 
are  overburdened  in  eliminating  this  excessive  waste,  for  they 
are  performing  extra  duty,  which  excess  in  living  or  a  slug- 
gish liver  imposes  upon  them,  and  this  may  excite  inflam- 
mation in  the  tissues  of  the  kidneys  and  develop  into  what 
is  known  as  Bright's  disease. 

This  very  interesting  exposition  of  the  deposit  of  lithates 
or  gravel  in  the  urine  will  naturally  suggest  that  when  the 
urine  is  overloaded  with  these  nitrogenous  products  nitrog- 
enous food  like  eggs,  cheese,  beef,  etc.,  should  not  be  eaten 
for  awhile,  and  that  a  vegetable  diet  should  be  principally 
relied  upon,  thus  giving  the  liver  a  vacation;  the  diet 
should  be  supplemented  with  plenty  of  clean  fresh  water, 
and  no  liquors  of  any  sort  should  be  taken  by  those  whose 
liver  is  affected. 

Starch,  sugar  and  fat  are  composed  of  carbon,  hydrogen 


398  HOME   TREATMENT. 

and  oxygen;  starches  and  sugars  are  termed  carbo-hydrates; 
because  the  hydrogen  and  oxygen  is  always  present  in  them 
in  equal  atomic  weights  so  as  to  represent  water;  while  in 
the  fats  the  oxygen  is  considerably  less.  This  is  exempli- 
fied by  comparing  the  chemical  equivalents  of  starch  and 
cane  sugar  with  those  of  fats : 

Starch Cw  Hlf  01#     Oleine C9i  H87  015 

Cane  sugar. . .  .C12  Hu  On     Margarine C™  H75  012 

When  starch  is  boiled  with  diluted  nitric,  sulphuric  or 
muriatic  acid  for  thirty-six  to  forty  hours,  it  becomes  color- 
less and  thin  like  water,  and  is  converted  into  a  species  of 
sugar.  A  similar  process  takes  place  when  starch  is  taken 
as  food,  the  diastase  of  the  saliva,  and  the  pancreatic  and  in- 
testinal juices  change  starch  into  glucose,  in  which  form  it 
is  ready  for  nutrition. 

Cane  and  other  sugars  introduced  into  the  system  as  in- 
gredients of  fruits  and  vegetables  are  not  absorbed  as  such 
but  undergo  a  process  of  digestion  which  converts  them  into 
grape  sugar  or  glucose;  after  that  they  are  suitable  for  nutri- 
tion and  absorption  into  the  blood,  but  not  before. 

The  digestion  of  starches  and  sugars  has  been  incidentally 
referred  to  as  not  taking  place  in  the  stomach  but  in  the 
upper  portion  of  the  small  intestine,  through  the  agency  of 
the  pancreatic  juice  which  has  the  peculiar  property  of  con- 
verting farinaceous  and  saccharine  matters  into  grape  sugar- 
But  this  transformation  into  grape  sugar  is  not  the  final 
product  of  digestion.  In  the  normal  process  of  intestinal  ab- 
sorption the  grape  sugar  is  taken  up  by  the  portal  capillary 
vessels  and  carried  to  the  liver,  where  under  the  influence  of 
this  organ  it  is  changed  into  liver  sugar  or  glycogen,  and  it  is 
as  glycogen  that  it  again  enters  the  circulation,  to  disappear 
in  the  lungs.  But  if  the  liver  from  disease  or  other  causes 
fails  to  perform  this  task,  the  glucose  passes  through  the  organ 
unaltered,  and  as  such  again  enters  the  circulation  where  it 
acts  as  an  irritant  and  finally  is  eliminated  by  the  kidneys 
in  the  urine  giving  rise  to  the  affection  known  as  diabetes. 


SOMETHING   ABOUT   DIET.  399 

We  have  learned  that  there  is  a  stomachic  digestion  and 
an  intestinal  digestion,  the  former  principally  for  meats,  or 
that  class  which  are  now  called  nitrogenous  foods,  while  the 
latter  is  confined  generally  to  starches  and  fats.  This  phys- 
iological fact  suggested  the  idea  of  feeding  dyspeptics  only 
on  such  food  as  is  not  acted  upon  in  the  stomach,  but 
passes  beyond  that  cavity  to  become  digested  in  the  small 
intestines,  giving  the  stomach  a  rest  as  it  were  so  that  it 
may  recuperate  and  gain  strength  while  the  system  is  be- 
ing fed  by  farinaceous  aliments.  While  a  superficial  glance 
justified  such  a  procedure,  a  moment's  reflection  proves  it  to 
be  a  delusion,  and  for  this  reason,  that  there  will  be  an  un- 
avoidable irritation  of  the  stomach  which  the  journey  of  the 
farinaceous  material  occasions  in  its  passage  through  the 
stomach,  and  the  insufficient  nutritive  value  of  a  simple  non- 
nitrogenous  diet  causes  a  rapid  loss  of  tissue  and  bodily 
strength;  hence  this  course  proved  itself  impracticable  and 
was  abandoned.  Then  again  the  experiment  was  tried  of 
putting  a  certain  class  of  dyspeptics  on  a  purely  meat  diet;  this 
had  one  fault  common  with  the  former  plan;  it  was  also  too 
one-sided,  and  the  system  suffered  for  want  of  fat  and  starch, 
and  secondly  peptones  were  not  always  formed  in  the  stomach 
from  a  deficiency  of  the  gastric  juice  or  an  impairment  of  its 
quality,  so  that  this  method  was  also  abandoned. 

Fats  belong  to  the  starches  and  sugars  as  heat  producers; 
they  are  insoluble  in  water,  and  by  boiling  them  in  caustic 
alkali  they  are  decomposed  into  soap  and  glycerine.  In  the 
cavity  of  the  stomach  fats  remain  unaltered;  the  heat  of  the 
stomach  may  melt  or  liquefy  them,  but  in  no  other  way  are 
they  changed.  They  are  also  digested,  like  the  starches,  in 
the  small  intestine  by  the  action  of  the  pancreatic  juice 
which  possesses  the  remarkable  property  when  brought  in  con- 
tact with  fatty  or  oily  matter  at  the  temperature  of  the  body 
of  emulsifying  it,  and  of  converting  the  fats  into  a  milky, 
white,  opaque  looking  fluid,  by  a  minute  subdivision  of  the 
oily  particles.     This  emulsion  of  the  fatty  and  other  sub- 


400  HOME   TREATMENT. 

stances  of  the  food  is  termed  chyle,  and  as  such,  the  fatty  sub- 
stances are  ready  for  absorption  by  the  absorbents  of  the  in- 
testinal tract.  Experience  teaches  that  a  deficiency  of  fat 
causes  scrofulous  diseases,  and  this  class  of  patients  have  gen- 
erally a  repugnance  for  fat;  this  is  another  illustration  of  the 
unreliability  of  patients  to  choose  their  own  food.  Professor 
John  H.  Bennet  first  pointed  out  the  usefulness  of  cod  liver 
oil  in  consumption  and  other  scrofulous  diseases,  and  directed 
attention  to  the  value  of  fat  in  the  nutrition  of  the  body. 

Dr.  Ferguson  made  extensive  observations  on  the  little 
children  of  the  factory  operatives  of  Lancashire,  Eng.  The 
children  were  principally  fed  on  tea  or  water  and  bread, 
little  or  no  fat,  bacon,  butter  or  cream,  and  they  grew  up 
into  puny  and  stunted  men  and  women,  while  those  who 
had  a  bread  and  milk  diet  grew  into  hardier  and  finer  hu- 
man specimens. 

Fat  is  also  an  essential  food  for  the  brain  and  general 
nervous  system;  the  lean  are  the  nervous  patients  and  not 
the  fat  and  sleek,  hence  fatty  food  is  considered  an  impor- 
tant diet  for  this  class  of  diseases.  The  brain  and  nerve  fat 
is  called  "lecithin"  and  a  little  phosphorus  enters  into  its 
composition.  Chronic  obstinate  neuralgia  has  often  been 
cured  by  the  administration  of  cod  liver  oil. 

Milk  is  the  only  single  article  of  diet  which  possesses  in 
itself  all  the  properties  to  supply  the  wants  of  the  system, 
and  it  may  be  profitable  to  give  this  subject  more  than  pass- 
ing notice.  It  is  the  natural  and  most  wholesome  food  for 
the  infant  when  it  can  suck  it  from  its  mother's  breast;  in- 
stinctively the  newborn  rolls  its  little  head  hither  and  thither 
in  search  for  this  fountain  of  infantile  life  and  however  great 
the  skill  of  the  chemist  in  approaching  the  composition  of 
mother's  milk,  he  can  never  produce  an  equally  good  substi- 
tute. Milk  contains  all  the  principles  which  are  necessary  for 
human  food,  the  nitrogenous,  the  oleaginous  and  the  sac- 
charine, and  these  are  blended  in  such  proportion  that  milk 
is  adapted  for  the  complete  nourishment  of  the  young  and 


SOMETHING   ABOUT   DIET.  401 

old.  In  no  other  single  substance  supplied  by  nature 
does  a  similar  combination  exist;  it  contains  the  material 
for  the  consolidation  of  bone  and  for  the  formation  of  the  red 
blood  corpuscles,  by  carrying  in  solution  the  phosphates  of 
lime,  magnesia  and  iron;  in  this  respect  an  analysis  of  milk 
shows  a  remarkable  similarity  to  blood.  The  proportions  of 
the  different  constituents  of  milk  are  liable  to  great  varia- 
tions and  are  greatly  influenced  by  the  nature  of  the  food. 
Dr.  Playfair  of  London,  who  has  made  some  interesting 
researches  regarding  the  milk  of  the  cow,  has  demonstrated 
that  the  amount  of  butter  depends  in  part  upon  the  quantity 
of  oily  matter  in  the  food  and  in  part  on  the  amount  of  ex- 
ercise which  the  animal  takes;  and  unon  the  warmth  of  the 
atmosphere  in  which  it  is  kept.  Exercise  and  cold  weather 
eliminate  the  oily  matter  or  butter,  in  the  form  of  carbonic 
•acid  and  water,  while  rest  and  warmth  diminish  this  drain 
by  favoring  its  passage  into  milk.  On  the  other  hand,  the 
proportion  of  the  cheesy  matter  is  increased  by  exercise. 

In  Switzerland,  where  the  cattle  pasture  in  very  exposed 
situations  and  where,  from  the  rolling  of  the  country,  they 
are  obliged  to  use  a  great  deal  of  muscular  exertion  the 
quantity  of  butter  yielded  by  the  cows  is  very  small,  while 
the  cheese  is  in  unusually  large  proportions;  but  the  same 
cattle  when  stall  fed  give  a  large  quantity  of  butter  and 
very  little  cheese. 

The  character  of  the  food  will  decide  the  nature  and 
healthfulness  of  the  milk.  The  best  food  for  milch  cows  is 
bran  or  middlings  mixed  with  well-seasoned  and  sweet-cut 
hay,  and  this  mixture  thoroughly  scalded  and  saturated 
with  boiling  water;  a  little  flaxseed  oil  cake,  should  be 
added  occasionally,  for  it  enriches  the  milk  and  keeps  the 
cattle  in  good  condition;  during  the  day  the  cows  should  be 
in  the  open  air;  they  should  not  be  irritated  by  dogs,  or 
made  to  run  or  trot;  these  things  will  affect  the  milk  injuri- 
ously. To  feed  cows  on  kitchen  garbage  or  swill  of  any 
sort  will  taint  the  milk  so  that  the  offensive  odors  of  the 
26 


402  HOME   TREATMENT. 

swill  can  be  readily  detected,  especially  after  the  milk  has 
stood  awhile;  such  milk  is  particularly  dangerous  to  infants 
and  should  at  once  be  discontinued.  Distillery  slops  are 
often  fed  to  cattle  in  large  cities;  these  are  not  only  produc- 
tive of  poisonous  milk  but  also  injure  the  cattle  so  that  they  be- 
come salivated  and  lose  their  teeth  after  a  few  years  of  this  diet 
Brewers' grains  are  not  open  to  the  same  objection  as  whisky 
slops;  a  certain  proportion  of  brewers'  grains  added  to  the 
cut  food  increases  the  flow  of  milk.  In  all  large  towns  there 
are  families  who  keep  one  or  two  cows  and  who  sell  the  milk 
as  a  means  of  making  a  livelihood:  as  a  rule  these  cattle  are 
fed  on  swill,  and  not  upon  the  best  quality  of  food,  and  al- 
though this  milk  is  recommended  as  being  pure  and  one 
cow's  milk,  it  is  as  a  rule  not  good,  for  the  stalls  and  the  food 
do  not  come  up  to  the  requirements  for  wholesome  milk. 

I  have  always  found  a  healthier  and  purer  milk  from  the 
dairies  run  on  a  large  scale,  and  outside  of  the  centers  of 
population.  The  cattle  look  healthier,  have  better  food, 
good  pasturage  and  pure  country  air,  and  if  the  milk  is 
properly  chilled  or  cooled  off  before  it  is  poured  into  the 
wagon  cans,  country  dairy  milk  is  to  be  greatly  preferred  over 
city  milk.  The  animal  heat  should  have  left  the  milk 
before  it  is  put  into  cans  for  transportation,  for  it  is  the  ani- 
mal heat  in  tightly  closed  vessels  which  causes  the  chemical 
changes  that  encourage  the  development  of  organic  milk 
poisons  or  so-called  ptomaines. 

Milk  promiscuously  mixed  from  a  group  of  apparently 
healthy  cows  is  preferable  to  that  of  one  cow,  and  for  several 
reasons;  the  honesty  of  dairymen  is  doubtful,  for  they  will 
not  take  the  extra  trouble  to  keep  the  milk  of  one  cow  apart 
when  the  cows  are  being  milked;  again  tuberculosis  or  con- 
sumption in  all  its  stages  is  a  common  disease  among  cattle, 
and  quite  often  a  milch  cow  has  tuberculosis  when  she  seems 
healthy.  If  a  child  should  subsist  on  the  milk  from  a 
tuberculous  cow,  serious  consequences  would  undoubtedly 
ensue,  but  if  this  milk  had  been  mixed  with  that  of  thirty 


SOMETHING    ABOUT    DIET.  403 

or  forty  healthy  cows,  the  danger  of  infection  would  be  cor- 
respondingly lessened. 

Cow's  milk  should  average  12  per  cent,  of  cream;  if  it 
contain  less  than  8  per  cent.,  it  is  probable  that  the  milk  is 
watered  or  that  it  was  skimmed.  A  cream  gauge  i.s  a  cylin- 
drical glass  vessel  about  one  and  a  half  inches  in  diameter 
a,nd  eight  inches  high,  with  a  capacity  of  12  fluidounces. 
This  tubular  measure  is  graduated  so  as  to  make  it  possible 
to  read  off  from  the  top  downwards  1,  2,  3,  etc.,  parts  or 
drams  of  cream  which  gradually  rises  to  the  surface.  This 
glass  is  filled  with  the  suspected  specimen  of  milk  up  to  the 
highest  mark  and  set  aside  for  24  hours,  at  an  ordinary  tem- 
perature; at  the  expiration  of  that  time  the  quantity  of 
cream  which  rose  to  the  surface  of  the  milk  is  read  off,  and  in 
this  manner  it  is  easy  to  see  the  proportion  of  cream  to  the  en- 
tire bulk  of  milk  tested.  Above  it  was  stated  that  12  per  cent, 
is  an  average  for  good  milk,  and  14  per  cent,  is  extra  good, 
while  8  per  cent,  is  the  lowest  that  is  permissible.  If  the  per- 
centage falls  below  8  per  cent,  it  is  a  sign  that  the  milk  has 
been  skimmed,  and  if  the  density  or  specific  gravity  is  below 
27  degrees,  then  it  is  to  be  presumed  that  the  milk  has  also 
been  watered,  for  sometimes  the  milk  is  both  skimmed  and 
watered. 

The  density  or  specific  gravity  of  milk  gives  an  approxi- 
mate idea  of  the  quantity  of  solid  matter  a  given  specimen 
submitted  for  examination  contains,  as  compared  with  pure 
water.  The  lactometer  or  galactometer  is  a  kind  of  hydro- 
meter, but  specially  graduated  to  readily  read  off  the  density 
which  pure  milk  should  have.  Pure  milk  at  a  temperature 
of  55  to  60  degrees  should  have  a  specific  gravity  varying 
between  27  and  33  degrees  and  if  the  sample  falls  below  27 
degrees,  it  is  to  be  presumed  that  water  has  been  added. 
The  density  of  diluted  milk  is  sometimes  maintained  by 
boiled  starch  water;  this  can  be  detected  by  adding  a  few 
drops  of  tincture  of  iodine,  which  changes  the  starch  into  a 
beautiful  violet  blue,  also  giving  the  adulterated  milk  a 
similar  tint. 


404  HOME   TREATMENT. 

It  must  always  be  remembered  that  while  milk  presents 
itself  in  a  liquid  form  it  becomes  a  semi-solid  in  the  stom- 
ach in  the  ordinary  process  of  digestion;  this  change  is 
accomplished  by  the  action  of  the  gastric  ferment,  curdling 
the  milk.  Milk  is  not  a  diluent  for  solid  foods  and  it  should 
never  be  drank  as  a  substitute  for  water  when  other  solid 
food  has  been  eaten.  The  practice  of  eating  a  regular  meal 
of  meat  and  vegetables  and  drinking  milk  at  the  same  time- 
invariably  overloads  the  stomach,  and  if  it  does  not  injure 
the  digestion  immediately  it  is  sure  to  do  so  in  time;  it  also 
furnishes  an  oversupply  of  nitrogenous  food,  developing  an 
excess  of  lithates  or  uric  acid,  and  this  burdens  the  liver  and 
kidneys.  If  a  person  is  fond  of  milk  it  is  most  excellent  as 
a  principal  article  of  diet  at  a  meal,  and  indeed  nothing  is 
better  than  a  bowl  of  well-prepared  mush  or  a  few  slices  of 
bread  with  a  pint  of  fresh  milk  for  either  breakfast  or  supper. 

Boiled  milk  has  considerable  healing  and  binding  virtues; 
it  may  be  thickened  with  a  teaspoonful  of  wheat  flour  to  the 
pint,  and  taken  quite  warm;  as  a  household  remedy,  it  is 
one  of  the  most  valuable  in  ordinary  cases  of  diarrhoea,  but 
no  other  food  should  be  taken  until  the  cure  is  effected. 

The  milk  cure  is  a  well-established  and  recognized  expe- 
dient for  the  relief  and  cure  of  a  certain  class  of  patients, 
and  as  the  success  of  the  regimen  depends  upon  an  intelli- 
gent employment  of  the  fluid,  it  becomes  necessary  to  enter 
somewhat  into  the  detail  of  its  administration. 

The  milk-shake,  that  is  milk  shaken  in  a  tumbler  or 
beaten  with  an  eggbeater  for  several  minutes  is  frequently 
borne  by  persons  who  cannot  digest  milk  which  has  not  been 
so  treated;  then  again,  a  teaspoonful  of  mush  or  gruel  added 
to  a  tumblerful  of  milk  and  thoroughly  beaten,  divides  the 
curd  mechanically  when  it  forms  in  the  stomach,  and  so 
makes  the  milk  much  more  soluble  by  the  gastric  juice. 

Milk  should  never  be  drank  cold,  but  at  a  temperature  of 
about  100°  F.,  which  is  about  as  warm  as  it  comes  from  the 
cow,  for  cold  delays  the  curdling  and  hence  the  digestion 


SOMETHING    ABOUT    DIET.  405 

of  the  milk,  and  gives  it  time  to  develop  acid  or  lactic 
fermentation  in  the  stomach,  and  this  may  cause  indi- 
gestion; a  pinch  of  salt  should  be  added  to  milk,  it  assists 
in  its  digestion.  There  must  be  certain  periods  at  which  to 
take  milk,  allowing  a  definite  interval  for  the  milk  to  digest; 
taking  milk  in  mouthfuls,  for  instance  as  a  drink  instead 
of  water  is  wrong,  for  this  will  ferment  and  occasion  indiges- 
tion. The  proper  length  to  intervene  between  each  meal  of 
milk  is  four  hours;  breakfast  8  o'clock,  dinner  at  12  o'clock, 
lunch  at  4  and  supper  at  8  o'clock;  if  the  patient  is  consid- 
erably exhausted,  the  time  between  8  o'clock  in  the  evening 
and  the  same  hour  in  the  morning  may  be  too  long,  and  if 
the  patient  is  awake,  a  meal  should  be  given  at  midnight. 

The  quantity  of  milk  which  may  be  taken  for  one  meal 
is  of  great  importance,  for  there  is  the  same  danger  of  taking 
too  much  of  this  food  as  of  any  other.  The  average  quan- 
tity to  begin  with  must  not  exceed  half  a  pint,  and  when 
the  appetite  is  capricious  one-fourth  of  a  pint  is  sufficient. 
It  is  now  fully  established  that  a  grown  person  can  be  fairly 
well  nourished  for  quite  a  while  on  one  quart  of  milk  in  the 
twenty-four  hours. 

It  is  also  of  considerable  importance  to  the  patient  that 
he  does  not  gulp  the  milk  as  this  would  cause  it  to  curd  into 
a  large  cohesive  mass  of  casein,  which  would  be  slowly  dis- 
solved or  acted  upon  by  the  gastric  juice,  and  might  give 
rise  to  distress  from  indigestion.  If,  on  the  other  hand,  the 
patient  sips  the  milk  slowly,  or  eats  it  with  a  spoon,  the 
curds  will  be  small  and  flaky  particles  which  even  a  weak 
stomach  may  digest.  There  are  quite  a  number  of  persons 
who  like  milk,  yet  whose  stomachs  do  not  take  to  it,  and  for 
these  a  milk  cure  might  be  just  the  thing.  It  requires  often 
a  great  deal  of  ingenuity  to  devise  a  plan  whereby  the  ob- 
stacle may  be  overcome.  The  first  step  should  be  to  shorten 
the  interval  between  each  meal  and  lessen  the  quantity  cor- 
respondingly; thus  to  give  the  patient  the  milk  every  hour 
would  imply  that  he  was  to  take  only  one-fourth  as  much  at 


406  HOME   TREATMENT. 

a  time  as  if  he  took  it  every  four  hours.  Perhaps  the  milk 
would  digest  more  easily  if  it  were  first  beaten  and  slightly 
seasoned  with  a  pinch  of  salt,  or  if  a  little  strained  gruel 
were  added  to  mechanically  divide  the  curd.  A  soda  cracker, 
toasted  bread,  or  the  rind  of  thoroughly  baked  wheaten  bread 
is  an  excellent  substitute  for  dividing  the  cheesy  substance 
of  the  milk  when  it  gets  into  the  stomach.  They  should  not 
be  soaked  or  dipped  into  the  milk  and  eaten  together,  but 
eaten  dry  and  thoroughly  masticated  until  the  saliva  has  re- 
duced the  bread  to  a  soft  pulp,  after  which  a  spoonful  of  milk 
should  be  taken  and  the  bread  stuff  washed  down.  The 
saliva  serves  another  useful  purpose  besides  moistening  the 
bread  as  it  changes  the  starchy  substance  into  sugar. 

In  other  cases  the  milk  sours  on  the  stomach,  and  then 
some  antacid  or  alkali,  like  lime  water  or  bicarbonate  of 
soda  should  be  added  for  several  days  or  until  the  disposi- 
tion to  lactic  fermentation  has  subsided.  If  notwithstanding 
every  precaution,  waterbrash,  heartburn,  or  a  heavy  op- 
pressed pain  in  the  stomach  occurs,  or  if  sourish,  slimy 
secretions  are  vomited,  the  milk  cure  must  be  abandoned 
for  something  else. 

Diarrhceal  diseases  of  infants  who  are  fed  on  cow's  milk 
are  caused,  in  many  instances,  by  germs  or  spores  that  get 
into  the  milk  from  lack  of  proper  cleanliness  and  from  the 
unavoidable  exposure  of  the  fluid  to  the  atmosphere  of 
stables  and  dairy  rooms  where  the  milk  is  handled  before 
transportation  to  consumers.  To  obviate  the  danger  of  feed- 
ing nurslings  with  infected  milk,  and  to  destroy  the  vitality 
of  germs  which  find  access  to  the  milk,  methods  have  been 
devised  for  sterilizing  the  milk.  This  process  was  first  pro- 
posed in  1886  by  Professor  Soxhlet,  and  has  ever  since  gained 
favor  with  the  profession;  it  consists  of  exposing  the  milk  to 
a  temperature  of  live  steam  or  boiling  water  for  about  forty- 
five  minutes.  In  New  York  City  there  are  two  reliable  firms 
which  sterilize  milk  at  the  dairy  in  the  country  and  ship  it 
to  the  city. 


SOMETHING   ABOUT   DIET.  407 

In  all  the  methods  of  sterilization  the  milk  is  placed  in 
six  or  eight-ounce  hottles  and  set  on  a  tray  or  shelf,  which 
stands  above  the  water  at  the  bottom  of  a  vessel,  the  cover 
then  applied  and  the  water  made  to  boil  forty-five  minutes' 
a  perforated  stopper  is  inserted  into  each  flask,  admitting  of 
the  escape  of  air  and  gases  at  the  beginning  of  the  heating 
process.  The  stopper  may  consist  of  cork  with  a  glass  tube 
in  the  center,  or  cotton,  or  of  rubber  with  a  channel  a  part 
of  the  distance  on  one  side.  If  necessary  the  family  can  im- 
provise their  own  apparatus;  an  inverted  tin  pan  will  serve 
the  purpose  of  a  tray  to  support  the  nursing  bottles,  and  this 
placed  in  the  bottom  of  an  ordinary  tin  vessel  with  a  cover 
completes  the  contrivance.  The  milk  is  to  be  prepared  as  it 
is  to  be  administered,  that  is,  the  proper  quantity  of  water, 
a  little  sugar,  and  the  point  of  a  penknifeful  of  bicarbonate 
of  soda  added,  and  distributed  among  as  many  eight-ounce 
flasks  or  nursing  bottles  as  the  child  is  fed  during  the 
twenty-four  hours;  thus  if  fed  every  four  hours  the  milk 
should  be  distributed  among  six  flasks,  and  if  fed  every 
three  hours,  it  would  require  eight  flasks.  When  the  milk 
has  been  sterilized,  it  keeps  sweet  for  an  indefinite  period 
at  ordinary  temperature;  the  bottle  is  to  be  well  shaken  to 
mix  the  cream  before  the  cork  is  removed  and  the  nipple 
applied. 

When  an  apparatus  or  a  sufficient  number  of  flasks  can- 
not be  readily  obtained  I  have  the  milk  boiled  in  a  fruit  jar 
after  the  manner  of  making  beef  tea,  as  follows:  A  quart 
preserve  jar  is  filled  with  milk,  obtained  not  later  than  four 
to  six  hours  after  milking,  the  cover  is  lightly  put  on,  to 
allow  the  escape  of  air  and  gases,  and  then  the  jar  is  put 
into  a  vessel,  on  the  bottom  of  which  an  inverted  pan  has 
been  placed  so  that  the  preserve  jar  does  not  rest  on  the 
bottom  of  the  vessel  where  the  heat  would  crack  it;  the 
vessel  is  then  to  be  filled  a  third  with  water,  and  this 
boiled  for  an  hour,  after  which  the  jar  is  carefully  closed, 
as  in   preserving  fruit,  until   wanted   for  use.     The  milk 


408  HOME   TREATMENT. 

should  be  kept  in  a  cool  and  clean  place,  and  only  as  much 
measured  out  each  time  as  is  required  for  one  mess,  after 
which  immediately  close  the  jar.  The  water  that  is  to  be 
used  for  diluting  the  milk  must  have  been  thoroughly  boiled; 
it  is  always  better  to  prepare  and  dilute  the  milk  before  ster- 
ilizing it  for  very  young  infants,  but  when  they  are  a  year 
or  more  old,  the  boiling  water  may  be  added  at  each  meal. 

The  casein,  which  is  the  curd  or  coagulable  part  of  milk, 
differs  greatly  in  its  physical  property  in  the  milk  of  the 
cow  from  that  in  human  milk.  Mother's  milk  curds  in  soft 
flaky  coagula  which  are  readily  dissolved  in  the  infant's 
stomach,  while  cow's  milk  curds  in  a  semi-solid  conglom- 
erate coagulum  which  the  cavity  of  the  child's  stomach  is 
often  unable  to  tolerate  nor  the  gastric  juice  to  penetrate 
and  dissolve.  It  is  this  heavy  curd  which  forms  the  main 
objectionable  feature  of  cow's  milk  as  a  substitute  for  that 
of  the  mother.  This  can  be  greatly  modified  by  first  thor- 
oughly beating  or  churning  the  cow's  milk  with  an  egg 
beater,  and  afterwards  scalding  it  as  above  described ;  the 
milk  treated  in  this  manner  curds  light  and  flaky.  But  it 
must  not  be  presumed  that  the  physical  characteristic  of 
casein  is  the  only  peculiarity  of  cow's  milk  in  comparison 
with  mother's  milk,  for  this  is  not  so;  it  also  differs  in  quan- 
tity, that  is,  mother's  milk  has  less  of  casein,  a  fact  which 
may  be  better  understood  by  the  following  chemical  analysis 
of  both: 

Human  milk.       Cow's  milk. 

Water 87.09  87.0 

Casein  and  albumen 2.48  3.72 

Fat 3.90  3.66 

Sugar  of  milk 6-04  4.92 

Phosphatic  salts 0.49  0.70 

100.00  100.00 

There  are  some  children  who  are  unable  to  digest  cow's 
milk  in  any  form,  either  from  a  peculiarity  of  constitution, 


SOMETHING   ABOUT   DIET.  4()9 

or  from  a  derangement  of  the  digestive  apparatus;  the  milk, 
no  matter  how  prepared,  passes  through  them  curdled,  in 
lumps  and  undigested;  to  continue  feeding  infants  on  milk, 
notwithstanding  this  symptom  would  in  all  probability  sac- 
rifice the  life  of  the  child.  If  curds  persist  in  the  stools 
milk  is  to  be  withheld  for  a  time,  and  crushed  wheat,  barley 
gruel  or  other  diluents  should  be  given  alone  or  in  combi- 
nation with  the  thoroughly  beaten  white  of  egg.  This 
treatment  must  be  continued  for  several  days  and  in  some 
cases  for  several  weeks. 

Whey  prepared  from  sweet  and  pure  milk  has  often  been 
borne  by  delicate  and  suffering  infants,  when  nothing  else 
could  be  retained.  An  examination  into  the  chemical  com- 
position of  whey  reveals  astonishing  nutritive  virtue,  which 
it  holds  in  solution;  the  following  table  shows  the  propor- 
tional constituents  in  one  hundred  parts: 

Water D3.31 

Nitrogenous  matter 0.82 

Fat  or  butter 0.24 

Sugar  of  milk 4.98 

Fixed  salt 0.G5 

When  the  whey  is  the  product  of  soured  milk,  0.33  or  more 
of  lactic  acid  is  to  be  added  to  this  analysis,  and  the  same 
amount  deducted  from  the  sugar  of  milk.  Essence  of  pepsin 
will  curd  lukewarm  milk,  not  warmer  than  can  be  agreeably 
borne  by  the  mouth ;  a  temperature  higher  than  one  hundred 
and  fifteen  degrees  Fahrenheit  destroys  thecurdling  principle 
of  the  pepsin.  The  quantity  of  essence  of  pepsin  to  be  used  to 
the  pint  of  milk  depends  on  the  strength  of  the  preparation; 
usually  a  teaspoonful  or  two  is  added  and  stirred  just  enough 
to  mix;  let  it  stand  till  firmly  curded,  then  beat  up  with  a 
fork  until  the  curd  is  finely  divided;  now  strain  and  the 
whey  is  ready  for  use;  it  should  be  sweetened  a  little;  sugar 
of  milk,  if  pure,  would  be  the  best,  otherwise  white  cane 
sugar  may  be  used.  A  newborn  babe  will  require  a  table- 
spoonful  to  begin  with,  every  two  hours,  always  slightly 


410  HOME   TREATMENT. 

warmed.  It  is  particularly  essential  to  keep  everything 
clean,  especially  the  tube  and  nipple;  these  are  to  be  brushed 
and  cleaned  after  each  meal,  and  then  laid  on  a  clean  dry 
plate  for  future  use;  the  nursing  bottle  too  must  be  rinsed 
and  drained.  The  prevalent  custom  of  keeping  the  tube, 
nipple  and  bottle  in  water  after  they  are  washed  is  a  bad 
one,  for  to  have  them  sweet  and  pure  they  should  be  allowed 
to  dry  out  between  times. 

Condensed  milk  is  often  a  valuable  substitute  for  fresh 
cow's  milk;  its  utility,  is  probably  due  to  the  employment 
of  heat  in  its  manufacture,  which  destroys  the  germs  or 
spores  that  find  their  way  into  all  milk,  and  to  the  scald- 
ing of  the  casein  which  modifies  its  physical  character  so 
that  it  no  longer  curds  into  large  lumps  when  in  the  stomach, 
but  into  smaller  flakes.  There  are  different  brands  in  the 
market,  and  even  the  best  of  them  may  be  too  old  and  shop 
worn;  they  then  become  thick  and  dark  in  which  condition 
they  are  no  longer  fit  for  infants'  food.  The  Eagle  and 
Anglo-Swiss  are  among  the  best  varieties;  others  contain 
too  much  sugar,  while  some  are  adulterated  with  starch  or 
flour.  A  heaping  teaspoonful  of  condensed  milk  to  a  tea- 
cupful  of  warm  water,  previously  boiled,  is  the  average 
strength,  although  better  results' are  obtained  when  a  thin 
gruel  of  corn  starch  or  arrowroot  is  employed  instead  of  plain 
water;  when  the  child  grows  older  cracked  or  rolled  oats 
or  graham  flour  may  be  substituted  for  the  arrowroot.  The 
gruel  is  prepared  in  the  following  manner:  take  half  a  tea- 
cupful  of  oatmeal  or  graham  flour,  saturate  first  with  cold 
water,  then  stir  slowly  into  three  pints  of  boiling  water;  add 
a  pinch  of  salt  and  boil  over  a  slow  fire  for  three-quarters  of 
an  hour,  stirring  constantly  so  that  it  will  not  scorch  on  the 
bottom;  then  strain,  and  if  it  has  boiled  down  to  less  than  a 
quart  of  gruel,  add  a  sufficient  quantity  of  boiling  water 
through  the  strainer  to  make  it  measure  a  quart. 

The  gruel  is  to  be  prepared  fresh  every  morning,  and  the 
above  quantity  will  last  about  twenty-four  hours.     It  should 


SOMETHING    ABOUT    DIKT.  41 1 

be  kept  in  a  porcelain  or  glass  pitcher  covered  with  a  nap- 
kin, and  set  aside  in  a  clean  cool  place.  At  regular  meal- 
times take  out  the  required  quantity,  warm  in  a  little  agate 
saucepan,  kept  only  for  this  purpose,  and  when  warmed  add 
the  condensed  milk,  stirring  until  it  is  dissolved.  This 
makes  a  fine  cream-like  food,  agreeable  to  take  and  very 
nourishing  if  well  borne  by  the  stomach.  The  stools  may 
become  too  loose  at  times  from  the  oat  or  wheaten  gruel,  then 
this  gruel  should  at  once  be  changed  for  that  of  corn  starch  or 
arrowroot  until  the  bowels  are  regulated  again,  and  when 
that  is  done  it  may  be  advisable  to  return  to  the  oatmeal 
or  cracked  wheat.  The  exercise  of  a  little  judgment  and 
close  observation  in  feeding  a  child  will  contribute  greatly  to 
its  wellbeing;  any  diarrhoea  or  disturbance  of  the  digestion 
must  at  once  receive  prompt  attention  and  this  can  often  be 
accomplished  by  change  of  food;  to  allow  these  disorders  to 
run  for  any  length  of  time  is  to  invite  serious  consequences. 

Adults  or  grown  persons  have  also  their  share  of  stomach 
troubles;  as  a  rule  they  eat  too  much,  too  fast  and  do  not 
masticate  their  food  sufficiently.  It  is  not  so  much  what  a 
person  eats,  but  how  he  eats,  not  so  much  quality  as  quan- 
tity. 

After  an  exclusive  dietary  of  milk  dyspeptics  should 
gradually  return  to  a  mixed  diet,  that  is  a  regular  dinner 
once  a  day;  but  eat  slowly  and  masticate  thoroughly;  thus 
one  eats  rarely  if  ever  too  much.  When  the  food  is  bolted, 
it  makes  little  or  no  impression  on  the  nerves  of  taste,  nor 
does  it  appease  the  sense  of  hunger,  and  the  only  indication 
of  satiety  is  a  feeling  of  fullness. 

As  to  the  time  of  taking  one's  dinner  that  depends  alto- 
gether on  the  occupation  and  habits  of  the  individual.  In 
dyspeptics  in  whom  the  digestion  is  slow  and  the  circulation 
sluggish  the  principal  meal  or  dinner  should  be  eaten  at  noon ; 
this  gives  opportunity  to  move  about,  stimulating  the  circula- 
tion, hence  increasing  the  absorption  to  its  highest  point.  If 
a  man  eats  his  dinner  in  the  evening  and  afterwards  goes  out 


412  HOME   TREATMENT. 

• 

into  society  or  attends  amusements  the  late  dinner  is  not 
objectionable.  But  if  a  person  is  worn  and  tired  out  at  sup- 
per and  then  eats  a  hearty  meal,  and  lounges  around  the 
room  the  remainder  of  the  evening,  reading  the  newspaper 
or  otherwise  inactive,  he  is  quite  likely  to  feel  distress  from 
what  he  ate,  and  sure  to  experience  occasional  bilious  spells; 
nightmare  disturbs  his  sleep  and  he  awakes  in  the  morning 
unrefreshed,  languid  and  dull.  It  is  better  for  such  persons 
to  eat  their  dinner  at  noon,  and  retire  early  on  a  very  light 
supper. 

Beef  tea  became  very  popular  at  one  time  as  a  nourish- 
ment for  the  sick,  and  there  can  be  no  doubt  that  many  pa- 
tients who  were  stricken  down  with  different  acute  diseases 
slipped  into  their  graves,  because  beef  tea  was  relied  upon 
with  a  belief  that  it  was  a  sufficient  nourishment.  Observa- 
tion and  careful  researches  on  the  subject  have  proved  con- 
clusively that  the  nutritive  value  of  beef  tea  as  ordinarily 
prepared,  that  is  chopped  beef  put  into  a  bottle  and  boiled 
in  a  water  bath  for  three  or  four  hours,  has  been  greatly  ex- 
aggerated. The  process  of  boiling  the  beef  has  no  other  ef- 
fect than  that  of  drawing  out  the  watery  substance  of  the 
meat.  The  phosphatic  salts  that  are  contained  in  the  meat 
are  also  extracted  with  the  serum  which  holds  them  in  so- 
lution. The  natural  albuminoids  (musculine)  which  con- 
stitute the  real  nutritive  element  of  beef  are  congealed  and 
surrounded  by  the  fibrous  tissue — that  part  which  snarls 
up  and  renders  the  beef  gristly  and  tough.  Yet  as  a  nutri- 
tive stimulant,  beef  tea  possesses  attimes  considerable  value; 
it  is  an  excellent  vehicle  sometimes,  for  instance  an  egg 
thoroughly  beaten  and  added  to  a  cupful  of  warm  beef  tea 
is  a  desirable  form  of  liquid  food  for  invalids. 

Eggs  constitute  a  highly  nitrogenized  food  and  their 
nutritive  value  is  even  greater  than  that  of  stall-fed  beef. 
The  subjoined  tables  of  chemical  analysis  give  the  definite 
quantity  of  each  constituent  that  is  contained  in  one  hun- 
dred parts  of  egg  and  beef: 


SOMETHING   ABOUT    DIET.  413 

Stall-fed  Beef.  Ego.  Lean  Beef. 

Phosphatic  salt 0.5  1.0  1.5 

Albuminoids 10.5  15.0  17.:, 

Fat 45.0  12.0  6.0 

Water 44.0  72.0  75.0 

100.0  100.0  100.0 

If  we  compare  the  analysis  of  egg  with  that  of  milk,  a 
remarkable  similarity  will  be  observed,  save  one  exception, 
namely  the  carbo-hydrate  sugar  of  milk  is  lacking  in  eg"-, 
and  in  order  that  eggs  have  the  same  property  of  nourishing 
the  body  as  milk,  this  element  may  be  readily  supplied  by 
eating  a  little  bread.  The  writer  is  familiar  with  the  history 
of  a  case  in  which  a  patient  was  kept  on  an  exclusively  egg 
diet  for  five  months,  and  during  this  time  he  increased  his 
weight  thirty-eight  pounds ;  he  consumed  eight  eggs  and 
twelve  ounces  of  bread  a  day. 

We  hear  considerable  unfavorable  comment  in  regard  to 
hard-boiled  eggs,  and  indeed  for  good  and  sufficient  reason, 
but  the  indigestibility  of  the  hard-boiled  egg  is  not  due  to 
any  change  in  the  nature  of  the  albumen  because  it  is  boiled; 
the  cause  is  entirely  mechanical.  The  reason  is  that  a  hard- 
boiled  egg  is  not  sufficiently  divided  by  the  ordinary  proc- 
ess of  mastication  to  allow  the  gastric  juice  to  attack  it  from 
all  sides;  if  it  were  finely  pulverized  either  by  the  teeth  or 
otherwise  it  would  be  as  readily  digested  as  a  soft-boiled  or 
raw  egg. 

A  raw  fresh  egg  that  is  thoroughly  beaten  with  an  egg 
beater  is  the  most  readily  digested  food  that  there  is.  The 
author  has  known  dyspeptics  who  could  not  digest  any  other 
kind,  and  by  adding  a  pinch  of  salt  and  half  to  one  table- 
spoonful  of  whisky  after  it  is  thoroughly  beaten,  it  is  cer- 
tainly one  of  the  most  valuable  foods  for  a  certain  class  of 
stomach  troubles  that  can  be  recommended.  Patients  whose 
digestion  is  very  weak  should  begin  with  one  egg  every  four 
hours  until  four  eggs  are  taken  during  the  day;  when  the 
strength  increases,  two  may  be  taken  for  breakfast,  and  one 
for  each  meal  the  rest  of  the  day ;  after  the  lapse  of  a  few 


414  HOME   TREATMENT. 

days  another  may  be  added  to  the  second  meal,  and  so  the 
number  gradually  increased  until  eight  are  consumed;  pru- 
dence would  not  go  beyond  this  number  lest  an  excess  of 
nitrogenous  matter  overtax  the  liver  and  kidneys  to  elimi- 
nate it  from  the  system  and  this  result  in  other  complica- 
tions. 

Dyspeptics,  more  than  others,  must  avoid  overtaxing 
the  digestive  organs,  and  while  the  stomach  is  sensitive 
and  for  a  long  time  afterwards,  they  must  avoid  solid  food. 

The  quantity  of  bread  must  also  be  jealously  guarded; 
while  the  stomach  is  very  sensitive  and  weak  it  had  better 
be  entirely  suspended  and  when  resumed  no  more  than 
three  ounces  should  be  eaten  at  each  meal  to  begin  with.  For 
those  dyspeptics  whose  stomachs  possess  average  digestive 
power,  and  who  require  a  nourishing  and  readily  digestible 
meal,  the  writer  would  recommend  for  breakfast  a  milk 
gruel  to  which  a  raw  egg  has  been  added:  he  directs  that 
four  tablespoonfuls  of  oatmeal  mush  be  mixed  with  three- 
quarters  of  a  pint  of  warm  milk  and  this  worked  through  a 
tin  strainer  by  means  of  a  potato  masher;  to  the  milk  gruel 
so  obtained  and  again  moderately  warmed,  a  raw  fresh  egg 
is  added,  which  has  been  previously  beaten  to  a  foam,  and 
then  the  whole  mess  is  again  beaten  together,  seasoned  with 
salt  and  served  in  a  bowl. 

Medicines  should  play  a  very  minor  part  in  the  treatment 
of  dyspepsia;  the  artificial  pepsin  preparations  are  all  over- 
rated and  their  supposed  efficacy  is  due  to  a  careful  and 
regulated  diet  rather  than  to  the  virtue  of  the  pepsin.  If 
the  bowels  are  costive  and  if  the  stomach  is  sour  and  feels 
oppressed,  prescription  No.  n  will  materially  relieve  these 
symptoms. 

A  person  who  is  suffering  from  indigestion  must  above 
all  things  learn  to  discipline  himself;  when  that  has  been 
once  accomplished  the  task  of  carrying  out  an  appropriate 
diet  will  become  an  eas}^  one,  and  restoration  to  health  and 
strength  will  be  the  reward. 


INDEX. 


A  BORTION.     The  practice  on  the 

-*-*-     increase,  and  not  due  to  a  single 

cause,  113,  114,  115,  116. 

is  it  ever  justifiable?  111. 

meaning  of  the  term,  110. 

criminal,  101. 

Catholic  Church   is  decisive  on, 
112. 
Abrupt  termination  of  pregnancy  con- 
stitutes a  disease,  117. 
Abscess  in  peritonitis,  278. 

in  perimetritis,  278. 

of  the  breast,  340. 
Abuses  of  surgery,  19. 
"A  bad  getting  up,"  204. 
A  husband  should  not  cease  to  be  a 

gentleman,  94. 
A  little  reflection,  250. 
Academicians'  view  of  fetal  life,  102. 
Acton,    Dr.        "  A   warning    against 

sexual  dangers,"  92. 
After  the  delivery,  334. 
Amenorrhcea,  132,  133. 
Anatomy  of  the  female  organs,  119. 
Antefiection  of  the  womb,  242. 
Anteversion  of  the  womb,  240. 
Antidotes  to  poisons,  3S9,  390,  391. 
Antiseptic  precautions,  75. 
Apostoli,  Georges,  Dr.,  298,  301. 
Arnold,  Prof.,  on  cancer,  218. 


B 


ABY,  barbarous  practice  of  bath- 
ing, 337. 
care  of  the,  337. 


Baby,  first  toilet  of  the,  338. 
Bacteria,  286. 
"Bad  getting  up,"  144. 
Bandaging  after  delivery,  250. 
Bartholow,  Prof.,  296. 
Battery,  294,  295. 
Beef  tea,  412. 
Bennet,  John  H. ,  400. 
Bennett,  Dr.,  196,  197. 
Berkeley,  Bishop,  47. 
Bladder,  catarrh  of,  163. 

catarrh,  and  other  diseases,  157. 

chronic  catarrh  of,  164. 

hemorrhage  of,  168. 

inflammation  of,  158,  159. 

in  pregnancy,  308. 

irritability  of,  252. 

nervous  irritability  of,  166. 

paralysis  of,  167. 

ulceration  of,  163. 
Braid,  Dr.  (discoverer  of  hypnotism), 

54. 
Brain,  fat  an  essential  food  for  the, 

400. 
Braine,  Dr.  Woodhouse,  51. 
Breast,  or  mammae,  of   the  pregnant 
woman.  31S. 

abscess  of,  340. 
Bright's  disease,  397. 
Broken  bones,  378. 
Bronchitis,  350. 
Brown-Sequard,  394. 
Burns  and  scalds,  382. 

classification  of,  383. 

useful  application  for,  385. 
415 


416 


INDEX. 


CAMPBELL,     DR.    HENRY    F.. 
254. 

Cancer,  Prof.  Arnold  on  diagnosis  of, 

218. 
Carbolic  acid,  poisoning  from,  3S9. 
Carbonic-acid  poisoning  in  chlorosis, 

135. 
Carpenter,  Prof.  W.  B.,  48. 
Castration,  274. 
Catarrh  of  the  womb,  219. 
cause  of,  213. 
symptoms  of,  215. 
vaginal  and  uterine,  177. 
Catarrhal  inflammation  of  the  womb, 
209. 
of  the  mouth,  342. 
Cellulitis,  pelvic,  285. 
in  childbed,  288. 
Cervical  endometritis,  211. 
Charcot,  Dr.     Experiments  in  hypno- 
tism, 54. 
on  "  Impersonal  Sleep,"  54. 
Chicken-pox,  375. 
Childbed  fever,  my  first  case,  74. 
Children  are  common  objects  of  love, 
9G. 
will  of,  53. 
diseases  of,  356. 
Chlorosis,  iron  in,  137. 
Chronic  inflammation  of  the  womb,  104. 

causes  of,  105. 
Clothing  to  avoid  taking  cold,  190. 
Coated  tongue,  341. 
Cohnheim,  Prof.,  his  theory  of  inflam- 
mation, 147. 
Coition  and  conception  widely  differ- 
ent processes,  106. 
Coitus,  injury  of  interruption  or  in- 
complete, 96. 
Cold,  injurious  effects  of  taking,  184, 

185. 
Colic  of  infants,  360. 
Conception,  independent  of  the  sexual 

act,  107. 
Conjugal  onanism,  Dr.  Devay,  96. 


Constipation,  366. 

causes  of,  366. 

in  pregnancy,  319,  320. 

treatment  of,  367. 
Continence,  95. 
Convulsions  in  children,  361. 
Corset  waist,  191. 
Cow,  exercise  of,  401. 
Cows'  milk,  403. 

cream  of,  403. 

density  of,  403. 
Croup,  348. 

false,  349. 

membranous,  349. 
Cutler,  Dr.  Ephraim,  298. 
Cystitis,  acute,  161. 

chronic,  162. 


D ALTON,    PROF.,    on    menstru- 
ation, 130. 
Dame  Nature,  41. 
Danger  of  overheating,  1S9. 
Darwinian   theory  applicable   to  the 

overcrowded  professions,  17. 
Days  of  doctrines  and  rules,  17. 
Delusions  as  to  the  curative  value  of 

drugs,  36. 
Depraved  associates  pave  the  way  to 

feticide,  114. 
Descartes,  48. 
Diarrhoea,  357. 

prescription  for,  357. 
in  pregnancy,  320. 
Diet,  392. 

morbid  fancy  for,  392. 
for  pregnant  women,  324. 
Digestion,  396. 

of  fats  and  starches,  399. 
Diphtheria,  346. 
Disease  is  as  much  a  vital  process  as 

health,  37. 
Diseases  of  children,  341. 

that  are  conjured  up  in  the  minds 
of  susceptible  persons,  25. 


INDEX. 


Disinfection  of  the  lying-in  woman  in 

Germany,  289. 
Dispersing  electrode,  299. 
Divided  skirts,  194. 
Dobell,  Dr.  Horace,  189. 
Drowning,  387. 

treatment  for,  388. 
Drug  diseases  of  Hahnemann,  43. 
Drugs  are  physical  agents,  44. 
Diivelius,  Dr.,  212. 
Dysmenorrhcea,  138. 

prescription  for,  142 

inflexion,  244. 
Dyspepsia,  or  indigestion,  137,  138. 
Dyspeptics,  411,  414. 


EGGS,  412,  413. 
Elastic  garters,  193. 
Electricity    in    diseases    of    women, 
297. 
as  a  remedy,  294. 
in  catarrhal  inflammation,  302. 
in  subinvolution,  303. 
medical,  296. 
without  puncture,  200. 
Electrodes  and  poles,  295. 
Electro-puncture,  298. 
Emergency  treatment  in  sudden  acci- 
dents, 377. 
Endometritis,  209. 

acute  and  chronic,  210. 
Engelman,  Dr.,  299. 
English  law  on  "  quickening,"  104. 
Epileptic  fits  cured  by  a  "  Christian 

Scientist,"  57. 
Equestrian  tights,  195. 
Erosions  often  mistaken  for   cancer, 

218. 
Eruptive  fevers,  370. 
Evans,  Dr.,  47. 
Exclusiveness  that  has  characterized 

the  professions,  16. 
Exercise,  must  be  interesting,  63. 
in  the  open  air,  62. 


417 

Expectation   or   attention    influences 
the  bodily  functions,  50. 


womb,  or  pro- 


Tj^AITH  cures  disease,  55. 
-*-       Falling  of    the    womb 

lapsus,  231. 
Fallopian  tubes,  124. 
Fats,  digestion  of,  399. 
Feeding,  intervals  between,  395. 
Ferguson,  Dr.,  400. 
Feticide,  101. 
Fire,  clothing  on,  384. 
Flexion  of  the  uterus,  139. 
Flexions  and   versions   due  to  abor- 
tions, 117. 
Floor  of  the  pelvis,  228. 
Flux,  358. 
Fly-blister,  causing   inflammation  of 

the  urethra,  152. 
Food,  repugnance  to,  393. 

liquid  for  invalids,  393. 
Fractures,  378. 

Fright  causes  and  cures  disease,  58. 
Frost-bite,  385. 

treatment  for,  387. 
Functional  diseases,  56. 


/GALVANOMETER,  300. 

^"      General  causes    of  uterine  and 
pelvic  diseases,  61. 

Germ  theory  of  disease,  77. 

German  measles,  372. 

Germans,  river-bathing  of,  77. 

Germicidal  properties  of  drugs,  176. 

Girls  should  be  independent  to  choose 
their  choice,  66. 

Gonorrhueal    infection,    statistics   of, 
276. 

Goodells,  Prof.,  on  "abuses  of  uter- 
ine treatment,"  22. 
on  uterine  symptoms,  140. 

Graafian  follicles,  263. 

Green  sickness,  133,  134. 


418 


INDEX. 


Growth  of  the  uterus  from  the  mo- 
ment of  conception,  72. 


HEMORRHAGE    of    the    womb, 
143,  144. 
of  woumls,  3S1. 
arrest  of,  382. 
Hemorrhoids,  causing  inflammation  of 
urethra,  152,  322. 
in  irritability  of  bladder,  166. 
Heroic  treatment,  42. 
Hippocrates's  view  of  fetal  life,  102. 
Histology  of  inflammation,  145. 
How  a  woman  should  lie  after  con- 
finement, 335. 
Human  ovum,  size  of,  2G4. 
Hygiene  of  gynecology,  78,  79. 
Hygienic  measures,  182,  183. 
Hypnotism,  52. 
Hysteria,  amenable  to  mind  cure,  56. 


ICE-BAGS,  291. 
Imagination  is  the  realm  of  the 
soul,  49. 
Impersonal  sleep  of  Dr.  Charcot,  54. 
Improprieties  of  dress,  68,  69,  70. 
Imprudence     during     menstruation, 

71. 
In  the  realm  of  thought  there  is  no 

monopoly,  15. 
Indigestion,  35l5. 
Infants  fed  on  cows'  milk,  406. 

overfeeding  of,  394. 
Infection,  2S7. 

gonorrhceal,  81. 
innocent,  81. 
Inflammation,  145. 
of  the  womb,  196. 
chronic,  203. 
Interpolar  regions,  297. 
Intra-abdominal  pressure,  233. 
Involution,  73. 
Iron  pills  in  chlorosis,  137. 


T7"  NEE-CHEST  posture,  254. 
-■-*-     in  relaxed  vagina,  180. 
in  falling  of  the  womb,  236. 


LAITY,  object  of  educating  the,  IS. 
Landois,  Prof.,  on  the  curative 
force   in   the   lower    animals, 
39. 
Laws  on  abortion,  104,  105. 
Leucorrhcea,  80,  176. 
Little  girls,   muco-purulent  secretion 

of  the  vagina,  152. 
Lochial  discharge,  84. 
Lung  fever,  352. 

Lying  on  the  back  after  confinement, 
73. 


MALTHUS,  law  of,  99. 
Man,  instinctive  desire  of,  89. 
Mania  for  cutting  operations,  21. 
Marital  excesses,   and  prevention  of 

conception,  87. 
Marital   excesses   the  mainspring  of 

disease,  91. 
Married  women  exposed  to  infectious 

contamination,  80. 
Martin,  Dr.,  of  Chicago,  300. 
Massey,  Dr.  G.  Batton,  297. 
Measles,  370,  371. 
Measurements  of  the  healthy  uterus, 

71. 
Mechanical  age,  19. 
Menopause  and  puberty,  129. 
Menorrhagia  and  metrorrhagia,   143, 

144. 
Menstrual  disorders,  131. 
Menstruation   and    meustrual    disor- 
ders, 126. 
Menstruation,     average     period     of, 

128. 
precocious,  132. 
source    from    which    the    blood 

comes,  128. 


INDEX, 


419 


Menstruation  suspended  during  preg- 
nancy, 129. 
Menstruation,  climate  and  tempera- 
ment, 127. 
Menstruation,     diversity     in      ages, 

126. 
Mental  photography  in  the  hypnotic 

state,  54. 
Mesmerism,  52. 
Metritis,  190. 

acute,  19S. 

causes  of,  199. 

chronic,  203. 

cold  applications  in,  201. 

treatment  for,  200,  207,  208. 
Metrorrhagia,  143. 
Milk,  400. 

analysis  of,  408. 

arrowroot  with,  410. 

boiled,  404. 

condensed,  410. 

gruel  for,  410. 

diarrhceal  diseases  from,  400. 

from  the  country,  402. 

promiscuously  mixed,  402. 

quantity  to  be  taken,  4C5. 

sterilizing  the,  400. 

shake,  404. 
Milk-leg,  290. 
Mill,  John  Stuart,  99. 
Milliampere,  300. 
Moral  restraint,  90. 
More     thought     required     to     make 
good     mothers     than     to     file 
briefs   or   write    prescriptions, 
68. 
Morning-sickness,  300. 
Morphine  habit  vice  asthma,  60. 
Mouth,  catarrh  of  the,  342. 

putrid  sore,  342. 
Mucous  membraue,  1S2. 
Mumps,  344. 
Murchison,  Dr.,  397. 
Mystic  union  of   the  soul  with  the 
body,  102. 


^TAVEL,  care  of  the,  338,  339. 

-^    Nerve  strain,  140,  141,  152. 

Nervous  and  congestive  dysmenor- 
rhea, 140. 

Nervous  system  in  chlorosis,  135. 

Nervousness,  due  to  excessive  men- 
tal application,  03. 

Negative  pole,  301. 

Nine  years  of  my  professional  life,  15. 

Noeggerath,  Dr.,  on  gonorrheal  in- 
fection, 270. 


OBJECT  of  educating  the  laity,  18. 
Ovaries,  124. 
acute  inflammation,  200,  207. 
chronic  inflammation,  270. 
cysts  or  tumors  of,  204. 
diseases  of,  203. 
displacement  of,  200. 
incomplete  or  rudimentary,  206. 
supernumerary,  205. 
Ova,  number  discharged  at  the  men- 
strual period,  131. 
Ovaritis,  266,  267. 

treatment  of,  239,  272. 


PAIN  in  the  abdominal  walls,  321. 
Painful  sensations   from  imagi- 
nary causes,  48. 
Painless  childbirth,  325. 
Palpitation  of  the  heart,  321. 
Parametritis,  2S5. 
Parotitis,  344. 
Pelvis,  true,  120. 

false,  119. 

floor  of  the,  22S. 
Perimetritis  and  peritonitis,  275. 
Perineum,  121. 
Period  of  fruitfulness,  264. 
Peritonitis  and  perimetritis,  275. 
Peritonitis,  treatment  of,  282,  283. 

criminal  abortion  the  cause,  281. 
Piles,  322. 


420 


INDEX. 


Playfair,  Dr.,  401. 
Pneumonia,  352. 

treatment  for,  354. 
Poisons,  388,  389,  390,  391. 
Precocious    talents    should    not    be 

forced,  64. 
Pregnancy,  breasts  become  enlarged 
in,  308. 
bladder  trouble  in,  321. 
constipation  in,  319,  320. 
capricious  appetite  in,  307. 
deposit      of      coloring      matter, 

308. 
duration  of,  305. 
diet  in,  324. 
extra-uterine,  305. 
false,  306. 

menstruation  during,  306. 
nausea  and  vomiting,  319. 
salivation    of    the    mouth,    307, 

319. 
simulating,  314. 
symptoms  of,  305,  306. 
unnatural,  305. 
Pregnant     woman,     precautions    to, 
316. 
clean  linen  for  the,  318. 
proper  clothing  for,  315. 
Preliminary  signs  of  labor,  330. 
Preparation  of  homcepathic  dilutions, 

44. 
Prolapsus,   or  falling   of   the   womb, 

231. 
Protophytes,  286. 
Psychical  exaggeration,  140. 
Ptomaines    are   developed   from  un- 

cleanliness,  83. 
Puberty  and  menopause,  129. 
Puerperal  or  childbed  fever,  77,  78, 

290. 
Pulsation      of      the      fetal      heart, 

311. 
Putrefactive  germs,  286. 
Putrid  or  septic  poison,  287. 
Pyosalpinx,  285. 


QUICKENING,  103,  104,  310. 
Quinsy,  344. 


REPARATIVE  energy  of  nature, 
38. 
Reparative  process  after  confinement/ 

233. 
Retroflexion  in  pregnancy,  256. 

•     treatment  of,  252. 
Retroflexion  of  the  womb,  247. 
Retroflexion,    replacement    of,     254, 

255. 
Retroversion  of  the  womb,  246. 
Round  ligaments  of  the  womb,  248. 
Rose-rash,  372. 
Rumbold,  Dr.  Thos.  F.,  184. 


SALPINGITIS,  259. 
treatment  for,  260,  261. 

Sawyer,  Dr.  Herbert  C,  5S. 

Scalds,  382. 

Scarlet  fever,  373,  374,  375. 

Schelling,  William  Joseph,  47. 

Scrofulous  diseases,  400. 

Serous  membrane,  277,  278. 

Sexual  desire,  Prof.  Carpenter  on,  89, 
90. 

Sexual  instinct  not  unholy  and  de- 
praved, 109. 

Signs   and   symptoms  of   pregnancy, 
305. 

Signs  of  chronic  inflammation  of  the 
womb,  207. 

Skin,  or  integument,  182. 

Somnambulism,  52. 

Soor,  343. 

Sore  nipples,  339. 

Soxhlet,  Prof.,  406. 

Spasms  in  children,  361. 

Spermatozoa,  89,  100. 

measurements  of,  105. 

Spruce,  343. 

Stages  of  labor,  332. 


INDEX. 


421 


Sterility  in  flexion,  244. 

in  ovaritis,  272. 

due  to  abortion,  118. 
Sterilization  of  milk,  407. 
Stoics'  view  of  fetal  life,  102. 
Stricture  of  the  neck  of  the  womb, 

139. 
Stupidity  of  the  masses,  23. 
Subinvolution  of  the  womb,  73. 
Sugar,  digestion  of,  398. 
Superfluous  garments,  70. 
Sympathy  will  cause  disease,  58. 
Syringe,  proper  selection  of  a,  181. 


TEMPERATURE  for  living-rooms, 
189. 
Terror  causes  or  cures  disease,  58. 
The  bed  for  confinement,  329,  330. 
The  choice  of  a  physician,  328. 
The  care  of  the  baby,  337. 
The  nurse,  328. 

The  righting  of  the  organ,  331. 
Thermae,  76. 
Thrush,  341. 
Tonsilitis,  344. 

Too  much  mischievous  doctoring,  24. 
Tubal  dropsy,  259. 
Tuke,  Dr.  Daniel  H.,  50. 
Tying  the  cord,  336. 


UNCLEANLINESS    a    cause    of 
disease,  76. 
Union  suits,  194. 
Urethra,  121. 

gonorrhoeal  infection  of,  152. 
in  pregnancy,  155. 
in  the  newly  married,  156. 
inflammation  of,  150. 
irritation  of,  150. 
neuralgia  of,  155. 
Urethritis  and  neuralgia  of  the  ure- 
thra, 150. 
caused  by  eruptive  fevers,  152. 


Urethritis  in  pregnancy,  153. 

papillated   growths   and  mucous 

polypoids,  153. 
(  Urinary  fistula,  170,  171. 
Uterus,  123. 

anteflexion,  242. 

anteversion,  240. 

changes  after  confinement,  72. 

measurements  after  confinement, 

72. 
natural  position  and  support,  226, 

227. 
prolapsus,     or     falling     of     the, 

236. 
retroflexion,  247. 
retroversion,  246. 
treatment  for  prolapsus,  236. 
versions  and  flexions,  240. 


VAGINA,  122. 
catarrh  of,  175. 
catarrh  in  children,  177,  178. 
acute  and  chronic   inflammation 

of  the,  172. 
gonorrhceal  infection  of,  174. 
knee-chest  posture  in  catarrh  of 

the,  180. 
relaxed,  mistaken    for   falling  of 
the  womb,  179,  180. 
Vaginal  douches   after   confinement, 

335. 
Vaginal  injections,  directions  for  their 

use,  85,  86. 
Versions  and  flexions  due  to  abortions, 

117. 
Virchow,  Prof.,  theory  of  inflamma- 
tion, 146. 


WARMING  a  dwelling,  186. 
Weapon  ointment,  41. 
What  is  mind-cure  ?  46. 
What  is  termed  mind-cure  is  not  mind- 
cure,  40. 


422 


INDEX. 


When   the   soul   becomes    associated 
with  the  body,  107. 

When  to  begin  to  train  mothers,  65. 

Whey,  409. 

While  in  childbed,  328. 

Whites,  176. 

Whom  to  teach,  15. 

Whooping-cough,  367,  368,  369. 

Why  crowd  our  girls  into  the  profes- 
sion? 67. 

Winter  cough,  1S9. 

Wives  who  become  delicate  and  ner- 
vous, 93. 

Womb,  123. 

tear  or  laceration  of,  84. 


Women's  rights  vice  women's  wrongs, 

68. 
Women,  after  getting  up  from  con- 
finement, 74. 
Worms,  363,  364,  365. 
Wounds,  378. 

contused,  379. 

iucisetl,  379. 

lacerated,  379. 

poisoned,  3S0,  381. 

punctured,  379. 


I^IEGLER,  Prof.,  on  infection,  2S6. 


y  3/451 


A     000  741  529 


